"THE ROYAL FREE HOSPITAL AFFAIR."
2
403 thing I could only cut it out and put a silver plate i2?,, and I doubt if it ’ud answer." So the patient was taken home, and of course did" dee. " Some years ago, a relative of mine suffered from slight ulceration on the inside of the cheek, caused by a broken tooth. The tooth had been removed by a surgeon at Chesterfield, but thediseasedpart not readily healing the patient became alarmed; somebody told him it was " a cancer," and he came to consult the old charlatan at Manchester. He was told, of course, that it was "cancer," and ordered into lodgings. Every morning he attended at the surgery, and every morning for six months paid him. At length, when perhaps both were weary, or money enough had been extracted, the process of " keening" was suspended, the sore allowed to heal, and the patient went home, believing to this hour that he had been etired of a CANCER. Such is the usual practice. Manchester and the nineteenth century! what fools and rogues there are yet left to prevent a correct system of medicine! I pledge my honour to the literal accuracy of this recital. "Ex uno disce omnes." I am more anxious to sketch him correctly, because he was in his day the "Magnus Apollo" of surgical quackery in this benighted sooty land of factory chimneys, and he has left behind him not scores, but hundreds of quacks, who try to be as "blunt" as he, who can no more ape the true Abernethian style than they can rival the " Oadfiel-Lone" doctor in wealth, or the giant of Bartholomew’s in learning and talent. If I describe him, I describe the true Lancashire race of quacks. In the many large towns surrounding Manchester their name is legion. They are greatly glorious as "bone-setters," In the place where I am located, I will not say how many resident quacks we have in a population of ten thousand; I could if I would. But we are favoured every Friday with the visits of a very notorious member of this fraternity, who is "very clever at limbs," who rejoices in a third-rate druggist’s shop in a neighbouring town, sells physic for cattle, calls himself " doctor," and has a sign designating himself as " bone- setter" in letters half a foot long, and who, I understand is in very "comfortable" circumstances. With these worthies, every sprain of the ancle-joint with some swelling is of course dislocation; in their vocabulary, it is both out and broken;" a little salutary and useful " pulling," with two or three men to assist, satisfies the bystanders that the "doctor" has a " deal of nerve," not to be moved by the patient’s outcries ; a tight bandage or some " red-bottle" to rub with, is prescribed, and spite of so much ignorance and brutality the patient in time overcomes the doctor. I speak no falsehood when I say that multitudes of cases these last twenty years have occurred in which splints have been fraudulently applied to limbs that never were broken. In one case I remember necrosis, death, and slow removal of the whole shaft of the tibia, occurred as the result of pressure upon a sound limb, which, in their usual slang, was "broken in three places." In many such instances great is the glorification of the " doctor" at the rapid cure. I could go on multiplying my own recollections indefinitely. What is the plain matter-of-fact? Why, that such is the ignorance and stupidity, not of the working classes merely, but of their employers-of those who abet them and do the same thing-that in this locality if an accideiit-to a limb occur, fracture or dislocation, or supposed fracture or dislocation-if there be grievous and evident destruction of parts, the patient, if poor, may be sent to the Manchester Infirmary, but if an accident of ordinary character, the parties never think of ap- plying to the resident members of the Royal College of Surgeons ira the neighbourhood—if capable of removal, he is taken, or otherwise some notorious " bone-setter" some miles off is sent for,-perhaps our friend the horse-drug doctor, to whose flaming sign-board I just alluded,-and if he be absent, there are others equally clever. l’o have been brought up in a coccl-pit or a cotton-factory is here a sure passport to szcryicczl eminence, and this not with the poorei’ classes alone. Sir, I am not ashamed to put the subject before you in a pecuniary point of view. These people always insist on imme- diate payment, charge more in the long run than we should, and get it. They Clive no credit. Not long ago I attended an old woman with simple fracture of the tibia. I saw her every day, or nearly so for a month; was up with her in the first instance nearly all night. Somebody persuaded her to apply to our friend the " bone-setter." Of course, in his opinion, the case had been "very badly treated;" she saw him several times, and paid him each time. It was of no use my arguing with her. I modestly charged twenty shillings, and after two years the bill was unpaid, and for aught I know, is unpaid still. Now in London you are not tormented with these vermin; you know not what we miserable provincials have to contend with. Our great mill-owners send their work- people to them. With you a general practitioner in London has not perhaps much surgery; the hospitals are near, and access is easy to several well-known, operating surgeons. The " bone-setting" tribe cannot succeed in the metropolis. But remember London is not Great Britain. They thrive in Man- chester, spite of its infirmary- spite of Wilson and Turner and Jordan. Do not then legislate partially. Think of us. On the subject of quackery generally, an intelligent Catholic priest, conversing with me while waiting for a railway train, observed, " There is nothing to my mind so thoroughly English, or in which you differ so much from my country (France) as in this-in England all the stations are plastered over with ad- vertisements about quack pills. I think it very disgraceful your directors do not care how they make money." Fearing I have written at great length, I subscribe myself, Sir, yours very respectfully, JOSEPH ASHBURY SMITH, M.R.C.S., Surgeon to the whitteld Division Glossop, Derbyshire, March, 1854. of the Glossop Union. JOSEPH ASHBURY SMITH, M.R.C.S., Surgeon to the Whitfield Division of the Glossop Union. "THE ROYAL FREE HOSPITAL AFFAIR." To the E-c7itoi- of THE LANCET. SIR,—Although so much has been said and written by prejudiced partizans, and by envious periodicals, respecting the "Royal Free Hospital affair," it must be evident to every calm and disinterested looker-on, that the case has been most unfairly stated, and that a small clique have endeavoured to warp our best feelings and sympathies, on the assumed plea of public injustice and cruelty to a professional man; and have repre- sented the Editor of THE LANCET as being the instigator of the whole proceedings without being able to adduce one iota of £ proof, or even a shadow of evidence. Whilst I rejoice to find that there still exists so wide-spread an esprit de corps amongst us, I think it most essential to the high standing of our profession with the public, and even to its ultimate unity and co-operation within itself, that the cases it selects for the manifestation of its sympathy should bear the test of rigid and impartial inquiry. With this view we will now proceed to place Mr. Gay in a " Court of Equity." The evidence having been adduced, the Judge might "sum up" in somewhat the following manner:—" It appears that some months ago, a biography of Mr. Gay was published in a medical print, in which that gentle- man’s assumed high position in the profession, is stated as being due solely to his surgical genius, and to have been attained in spite of, rather than because of, his connexion with the Royal Free Hospital, which, in its turn, owes its reputation to the fact of having Mr. Gay as its medical officer. It goes on to throw contempt on the hospital, by hinting that it has probably been often mistaken for the prison and the ’penitentiary in its vicinity. The Committee of the Hospital feeling perhaps that a house divided against itself could not stand,’ called upon Mr. Gay publicly to disclaim all acquies- cence in these sentiments. This was met on the part of Mr. Gay by a refusal to publish any disavowal of these opinions, and by an assurance that he had not seen the biography previous to its publication. When cross-examined, he admitted that the proof-sheets had been in his house, but he still denied having seen them. Now I must here suggest to the jury, that it is not in accordance with the promptings of human nature to neglect the perusal of such a document previous to publication, and therefore there is a strong probability that Mr. Gay must have known that there were sentiments in it that it would be important for him to plead ignorance of at some future time. It may further be stated, that Mr. Gay circulated these biographies amongst his friends, and that he did not publish any denial or disapproval of the slur cast upon the hospital, nor has he done so to this hour; and at a meeting of the Governors, he stated ’there were grave reasons why he had not done so,’ and he , did not choose to tell the editor of the paper that he was zcrotzg ira what he had written.’ These reasons have not transpired, and probably never will; but I can probably form a tolerably correct surmise respecting them." I think the decision of any impartial person after hearing the case thus fairly put must be, "That the Committee and governing body of the Royal Free Hospital, were justified in requiring a public disclaimer of the sentiments contained in that biography, in interpreting a refusal to amount to a partici- ’ pation in these sentiments, and, under the impression that there , was a secret enemy in the camp, in requesting Mr. Gay to . resign.
Transcript of "THE ROYAL FREE HOSPITAL AFFAIR."
403
thing I could only cut it out and put a silver plate i2?,, and Idoubt if it ’ud answer." So the patient was taken home, andof course did" dee. "
Some years ago, a relative of mine suffered from slightulceration on the inside of the cheek, caused by a broken tooth.The tooth had been removed by a surgeon at Chesterfield, butthediseasedpart not readily healing the patient became alarmed;somebody told him it was " a cancer," and he came to consultthe old charlatan at Manchester. He was told, of course, thatit was "cancer," and ordered into lodgings. Every morninghe attended at the surgery, and every morning for six monthspaid him. At length, when perhaps both were weary, or
money enough had been extracted, the process of " keening"was suspended, the sore allowed to heal, and the patient wenthome, believing to this hour that he had been etired of a CANCER.Such is the usual practice. Manchester and the nineteenth
century! what fools and rogues there are yet left to preventa correct system of medicine! I pledge my honour to theliteral accuracy of this recital. "Ex uno disce omnes." Iam more anxious to sketch him correctly, because he was inhis day the "Magnus Apollo" of surgical quackery in thisbenighted sooty land of factory chimneys, and he has leftbehind him not scores, but hundreds of quacks, who try to beas "blunt" as he, who can no more ape the true Abernethianstyle than they can rival the " Oadfiel-Lone" doctor in wealth,or the giant of Bartholomew’s in learning and talent. If Idescribe him, I describe the true Lancashire race of quacks.In the many large towns surrounding Manchester their nameis legion. They are greatly glorious as "bone-setters," Inthe place where I am located, I will not say how manyresident quacks we have in a population of ten thousand; Icould if I would. But we are favoured every Friday with thevisits of a very notorious member of this fraternity, who is"very clever at limbs," who rejoices in a third-rate druggist’sshop in a neighbouring town, sells physic for cattle, callshimself " doctor," and has a sign designating himself as " bone-setter" in letters half a foot long, and who, I understand is invery "comfortable" circumstances. With these worthies,every sprain of the ancle-joint with some swelling is of coursedislocation; in their vocabulary, it is both out and broken;"a little salutary and useful " pulling," with two or three mento assist, satisfies the bystanders that the "doctor" has a" deal of nerve," not to be moved by the patient’s outcries ; atight bandage or some " red-bottle" to rub with, is prescribed,and spite of so much ignorance and brutality the patient intime overcomes the doctor. I speak no falsehood when I saythat multitudes of cases these last twenty years have occurredin which splints have been fraudulently applied to limbs thatnever were broken. In one case I remember necrosis, death,and slow removal of the whole shaft of the tibia, occurred asthe result of pressure upon a sound limb, which, in theirusual slang, was "broken in three places." In many suchinstances great is the glorification of the " doctor" at the rapidcure.
I could go on multiplying my own recollections indefinitely.What is the plain matter-of-fact? Why, that such is the
ignorance and stupidity, not of the working classes merely,but of their employers-of those who abet them and do thesame thing-that in this locality if an accideiit-to a limb occur,fracture or dislocation, or supposed fracture or dislocation-ifthere be grievous and evident destruction of parts, the patient,if poor, may be sent to the Manchester Infirmary, but if anaccident of ordinary character, the parties never think of ap-plying to the resident members of the Royal College of Surgeonsira the neighbourhood—if capable of removal, he is taken, orotherwise some notorious " bone-setter" some miles off is sentfor,-perhaps our friend the horse-drug doctor, to whose flamingsign-board I just alluded,-and if he be absent, there are othersequally clever. l’o have been brought up in a coccl-pit or acotton-factory is here a sure passport to szcryicczl eminence, andthis not with the poorei’ classes alone.
Sir, I am not ashamed to put the subject before you in apecuniary point of view. These people always insist on imme-diate payment, charge more in the long run than we should,and get it. They Clive no credit. Not long ago I attended anold woman with simple fracture of the tibia. I saw her everyday, or nearly so for a month; was up with her in the firstinstance nearly all night. Somebody persuaded her to applyto our friend the " bone-setter." Of course, in his opinion, thecase had been "very badly treated;" she saw him severaltimes, and paid him each time. It was of no use my arguingwith her. I modestly charged twenty shillings, and aftertwo years the bill was unpaid, and for aught I know, is
unpaid still. Now in London you are not tormented with
these vermin; you know not what we miserable provincialshave to contend with. Our great mill-owners send their work-people to them. With you a general practitioner in Londonhas not perhaps much surgery; the hospitals are near, andaccess is easy to several well-known, operating surgeons. The" bone-setting" tribe cannot succeed in the metropolis. Butremember London is not Great Britain. They thrive in Man-chester, spite of its infirmary- spite of Wilson and Turner andJordan. Do not then legislate partially. Think of us.On the subject of quackery generally, an intelligent Catholic
priest, conversing with me while waiting for a railway train,observed, " There is nothing to my mind so thoroughly English,or in which you differ so much from my country (France) as inthis-in England all the stations are plastered over with ad-vertisements about quack pills. I think it very disgracefulyour directors do not care how they make money." Fearing Ihave written at great length,
I subscribe myself, Sir, yours very respectfully,JOSEPH ASHBURY SMITH, M.R.C.S.,
Surgeon to the whitteld DivisionGlossop, Derbyshire, March, 1854. of the Glossop Union.
JOSEPH ASHBURY SMITH, M.R.C.S.,Surgeon to the Whitfield Division
of the Glossop Union.
"THE ROYAL FREE HOSPITAL AFFAIR."To the E-c7itoi- of THE LANCET.
SIR,—Although so much has been said and written byprejudiced partizans, and by envious periodicals, respecting the"Royal Free Hospital affair," it must be evident to every calmand disinterested looker-on, that the case has been most unfairlystated, and that a small clique have endeavoured to warp ourbest feelings and sympathies, on the assumed plea of publicinjustice and cruelty to a professional man; and have repre-sented the Editor of THE LANCET as being the instigator of thewhole proceedings without being able to adduce one iota of £
proof, or even a shadow of evidence.Whilst I rejoice to find that there still exists so wide-spread
an esprit de corps amongst us, I think it most essential tothe high standing of our profession with the public, and evento its ultimate unity and co-operation within itself, that thecases it selects for the manifestation of its sympathy shouldbear the test of rigid and impartial inquiry. With this viewwe will now proceed to place Mr. Gay in a " Court ofEquity." The evidence having been adduced, the Judgemight "sum up" in somewhat the following manner:—" It
appears that some months ago, a biography of Mr. Gaywas published in a medical print, in which that gentle-man’s assumed high position in the profession, is stated as
being due solely to his surgical genius, and to have beenattained in spite of, rather than because of, his connexionwith the Royal Free Hospital, which, in its turn, owes itsreputation to the fact of having Mr. Gay as its medical officer.It goes on to throw contempt on the hospital, by hinting thatit has probably been often mistaken for the prison and the’penitentiary in its vicinity. The Committee of the Hospitalfeeling perhaps that a house divided against itself could notstand,’ called upon Mr. Gay publicly to disclaim all acquies-cence in these sentiments. This was met on the part of Mr.Gay by a refusal to publish any disavowal of these opinions,and by an assurance that he had not seen the biographyprevious to its publication. When cross-examined, he admittedthat the proof-sheets had been in his house, but he still deniedhaving seen them. Now I must here suggest to the jury, thatit is not in accordance with the promptings of human natureto neglect the perusal of such a document previous to publication,and therefore there is a strong probability that Mr. Gay musthave known that there were sentiments in it that it would be
important for him to plead ignorance of at some future time. Itmay further be stated, that Mr. Gay circulated these biographiesamongst his friends, and that he did not publish any denial ordisapproval of the slur cast upon the hospital, nor has he doneso to this hour; and at a meeting of the Governors, he stated’there were grave reasons why he had not done so,’ and he, did not choose to tell the editor of the paper that he was zcrotzgira what he had written.’ These reasons have not transpired,and probably never will; but I can probably form a tolerablycorrect surmise respecting them."
I think the decision of any impartial person after hearing thecase thus fairly put must be, "That the Committee andgoverning body of the Royal Free Hospital, were justified inrequiring a public disclaimer of the sentiments contained inthat biography, in interpreting a refusal to amount to a partici-
’ pation in these sentiments, and, under the impression that there, was a secret enemy in the camp, in requesting Mr. Gay to. resign.
404
In arriving at this conclusion, we must remember that thecommittee are men of like passions and feelings as others; thatthey felt they had been treated with contempt, that their hos-pital had been vilified and reproached, and represented as ahindrance rather than an advantage to their medical officer.Neither must we quite forget, in our zeal for the profession,that if we give our time and skill, the committee and governorsgive their time and money, and that our efforts would be com-paratively useless without public benevolence. The governorshave, therefore, a fair right to complain of a medical officer whoseeks to depreciate the hospital to which he belongs.The interested few who got up the meetings at the Hanover-
square Rooms, having, upon feeble or false data, assumed acase of cruel injustice to a member of the profession, proceededto drag in THE LANCET as the originator of the whole matter,and seized upon this as a favourable occasion to pour out theirlong-pent-up spleen. I seek in vain for a single fact or argu-ment that can be adduced in support of this accusation. Onthe other hand. there is the evidence of Mr. Halswell, whooriginated the proceedings against Mr. Gay, that Mr. Wakleytook no part in them. At the very outset Mr. Wakley wrotea strong private letter to Mr. Gay, expressing his disapprovalof his conduct, and thus excluded himself and disqualifiedhimself from acting with the committee. Not a word wasever published in THE LANCET on the subject, and we mustremember that Mr. Gay was dismissed at two large generalmeetings of governors, in which it is well known Mr. Wakleytook no part whatever.
It is impossible not to admire the manner in which a largenumber of our profession came forward to defend one whomthey believed to be an injured brother; but the same high toneof honour, keen sensibility, and chivalrous feeling that promptedthis ready response to a call from one who assumed the garb ofmartyrdom, must, by degrees, ’bring about a reaction. Manywill see how difficult it is to disconnect Mr. Gay from that sadpiece of fulsome adulation, vanity, and spleen, that was pub-lished as his biography, since he had the proof-sheets in hispossession, circulated the pamphlet amongst his friends, andrefused to discountenance its contents, or publicly to disavowthem. They will see how natural it was for the governors of ahospital to feel sore at the aspersions and insults that were castupon their institution, and they will mark what a mean spiritof personal envy must have been at the root of the whole pro-ceeding, when THE LANCET was dragged in, and in the face ofevidence accused of influencing the decision of the governors.Any one who was present at the crowded meeting of the Medico-Chirurgical Society that assembled to outvote the de Morganclique, could trace abundant evidence all around him of such areaction. Nothing is wanted but calm reflection to convincethe profession they have taken up a case that will not bear fullinvestigation; that in unjustly censoring THE LANCET they arecommitting a suicidal act; they are depreciating a journal thathas embalmed and circulated all the best thoughts of their mosteminent men since the time of Abernethy-that still forms thechief link of communication between their members-that re-flects fairly and fully the practice of all their hospitals, and theopinions of their ablest writers—that upholds the best interestsof their profession, and deservedly enjoys a wide circulationand an Eurcpean celebrity.
I am, Sir, your obedient servant,London, April, 1854. A HOSPITAL SURGEON.
VARIOLA AND VACCINATION.
RICHARD EAGER.
To the Editor of THE LANCET.SIR,—A short time since, a case of small-pox made its ap-
pearance in a ward of the Infirmary of this Union, and of sosevere a nature as to destroy life. In consequence of this oc-currence, I examined the inmates of the house, and I foundthat about twenty of them had not been vaccinated; I conse-quently made application for a supply of lymph for the pur-pose of protecting them by vaccination: three or four dayselapsed before I could procure it. Thirty-six hours before theoperation, two boys, of the respective ages of fifteen and six-teen, were attacked by the premonitory symptoms of variola;I vaccinated both of them. In three or four days after the vac-cination, the eruption of pustules presented itself, and at thesame time the punctures on the arms were iniamed. The va-rioloid eruption advanced until the seventh day from its first
appearance, and the tenth from the vaccination, when thevesicles of the latter disease were in that state of advancementwhich they should have attained on the eight day, but afterthat time the pustules of small-pox were arrested in their pro-gress ; they never matured, but assumed the form of tubercu-
lated masses, raised above the surface of the skin, and passedaway without the formation of pus, whilst the vaccine vesiclesadvanced in the usual course, the areola, the scab, and its de.squamation being completely natural, except in the particularthat their progress was somewhat retarded. I am aware thatthese facts are not new ones, as I have observed them myselfin a previous case; at the same time interest attaches to them.If you think them worthy of a record, perhaps you will sparethem a space in an early number of your valuable journal.
I have the honour to be, Sir, your obedient servant,Guildford, March, 1854. RICHARD EAGER.
TREATMENT OF DIARRHŒA BY SULPHURIC ACID.
F. M. DAVIDSON.
To the Editor of THE LANCET.
SIR,—Having seen in THE LANCET sulphuric acid so stronglyand frequently recommended as a remedy for diarrhoea, I de-termined (as I had considerable opportunities of testing itsefficacy) to give it a fair trial. I have now before me notes of £fifty-two cases treated successfully with it. I administer thesulphuric acid in the following form :-Dilute sulphuric acid,two drachms; simple syrup, two clrachms; tincture of opium,forty minims; water, six ounces. The patient to take a sixth partof the above mixture after each loose motion; in many casestwo doses of the mixture are sufficient to check the diarrhœa.If the patient complains of cramp and pain in the abdomen,I order hot turpentine fomentations, and half or a third of agrain of morphia. If the vomiting is troublesome, a liberalsupply of ice is allowed, which in this town is easily procured.
Sulphuric acid, as a remedy in diarrhœa, has many and greatadvantages over the chalk mixture. The latter is exceedinglynauseous, but the sulphuric acid is so pleasant that it is readilytaken by children. It is decidedly more efficacious; it allaysthe thirst which accompanies diarrhœa; it is not precipitated;it is not afterwards followed by the troublesome constipationwhich attends the use of chalk mixture, and it is a very cheapremedy. Of course I do not administer the sulphuric acid inthose cases of diarrhœa arising from the presence of irritatingor non-digested food in the stomach or alimentary canal
Cholera (in all probability) will soon be here, and others,like myself, may perhaps be induced to try this truly valuableremedy in combating its premonitory diarrhoea.
I remain, Sir, your obedient servant,Bai-Mug, Essex, March, 1854. F. M. DAVIDSON.
THE ARMY AND NAVAL MEDICAL SERVICES.To the Editor of THE LANCET.
SIR,—A "notice" from the Limerick Chronicle of the 8th ofMarch, 1854, has appeared in a contemporary medical journal,but there is more in it than appears at a first reading. " TheRoyal Colleges of Surgeons, London, Edinburgh, and Dublin,have been called on by the War-Office for students of only twoyears’ hospital and lecture attendance, who will receive com-missions on the medical staff of the army. Each will receive£100 for an outfit."
This notice has been contradicted by authority. There is anabundance of medical candidates for the British army in all itsbranches. At -the present time the army authorities are notadmitting medical officers, and are employing, pro tempore, inmany districts civil practitioners. It is supposed this reluctanceto increase the medical staff arises from two motives—1st, thereis a remote chance of the war not lasting for more than a shortperiod; 2nd, the army medical staff is just now kept purposelystationary, that the candidates for the army, finding no imme-diate prospect of admission, may be induced to enter the navy.Thus the War-Office may be very clumsily touting for theAdmiralty. It is a marked coincidence that the city of Limerickis the head-quarters of the Royal Naval Coast Volunteers* onthe Irish station, and the Limerick Chronicle has a long-standing reputation for early and correct military intelligence.This "notice’’ appertains, it is rumoured, solely to the navy.The bounty of £100 for outfit is very charitable indeed. SinceSir James Graham’s reign at the Admiralty the great majorityof naval medical candidates have been from Ireland. Sir J.Graham knows full well that the Admiralty has treated themedical profession with insult, degradation, and neglect, andthat the naval authorities cannot appeal to the national medicalcolleges for assistance whilst " o6/:o;MOMS regulations" are inforce. Sir J. Graham has committed himself to statements asto the abundance of "applicants" for the naval medical service,
* The staff consists of—Captain Arthur Jerningham, (1851;) Surgeon Jas.Walsh, M.D., (1844;) Paymaster Edwin J. Forster, (1851.)
