942

THE LANCET.

LONDON: SATURDAY, JUNE 30, 1877.

THE ELECTION AT THE ROYAL COLLEGE OF SURGEONS.

MANY things affecting the interests of the professiongenerally, as well as some which more immediately concernthose of Fellows and Members, conspire to give the forth-

coming election at the Royal College of Surgeons specialimportance. The problems of medical politics are constantlybecoming more numerous and more complicated, the questionsof general and professional education yearly become more

pressing, and the demand for the admission of women intothe ranks of the profession is now more emphatic than ever.In the consideration of all these matters the Council of the

College of Surgeons, as the representatives of a large sectionof the profession, will sooner or later be called upon to takea very decided part, if they would preserve the influence and

dignity of the College and promote the welfare of its con-stituents. But in addition to these general questions thereare some which are more personal. In order to facilitate the

formation of a Conjoint Examination Scheme, the Councilhave, besides obtaining a special " Enabling Act," latelymade many important concessions, and have, indeed, prac-tically relegated most of their functions, so far as they relateto examinations, to the Committee of Reference. An in-

sidious attempt has been made, and even persisted in, bysome members of the Council, to rob the Fellowship ofits character and distinction, by sweeping away all the

old regulations which have hitherto demanded from the

aspirants for this honour evidences of a longer and bettercourse of professional training, of greater knowledge, andof higher general and scientific attainments, than are

required from those who seek merely a qualification to

practise. Happily the success of this attempt was checked

by the presentation, in March last, of a numerously-signedmemorial condemning a part of the new regulations, whilethe remaining portions have, for a time at least, beenrendered inoperative by the refusal of the Secretary of Stateto sanction their adoption. Lastly, it should not be forgottenthat the only reason why many women do not now possessthe certificate of qualification in midwifery is that the

examiners in midwifery (who were not otherwise connectedwith the College) resigned their offices rather than be

parties to the admission into the profession of women

who might be inadequately educated. The President

and the Vice-Presidents of that time had pronouncedthe certificates of three female candidates satisfactory,and the Council were content with this decision, andwould have admitted the candidates to examination if

they had not been prevented by the prompt resigna-tion of the midwifery examiners. The significance of

these reflections is briefly this: that it is incumbent on

the Fellows to look more closely into their affairs than theyhave hitherto done, and to show their spirit on Thursdaynext by selecting as their representatives only those whohave shown an interest in these questions, and a capacity to

deal with them. The candidates should be judged solely bytheir fitness to handle these matters, and not by mere pro-fessional status, although that is a qualification which shouldby no means be altogether disregarded.

It would be invidious to make special mention of the actionof any of the candidates with respect to the various subjectsreferred to; indeed, to do so is unnecessary, because everyFellow of the College who has taken any interest in themedico-political events of the past twelve months’ alreadyknows what part some of them have played. It is in

every respect desirable that the contest should be free

and open. The candidates are all of a high class, andall possess the respect and esteem of their professionalbrethren. The retiring members, Mr. GAY and Mr. ERICHSEN,have, as we have already said, each peculiar claims for re-election, which cannot in justice be disregarded, but there ismuch to be said on behalf of each of the other candidates.

Mr. ADAMS is senior, and has for many years taken the lead

among English surgeons in encouraging and advancing thescience and art of orthopaedic surgery, and has done much toraise our reputation on the continent and in America. Mr.

SAvoRy has always been a staunch supporter of the interestsof the profession, and yet an advocate of intelligent reform.His recent action with respect to the decision of the Senateof the University of London to admit women to the medicaldegree earned for him the thanks of all the medical graduatesof the University and every enlightened member of the com-munity. Mr. TIMOTHY HOLMES is the junior, and althoughpossessed of ability and merit, has not on this occasion anyspecial claim. He, moreover, with Mr. SAVORY, labours underthe serious disadvantage that he is a member both of theCourt and of the Board of Examiners. The Fellows should

not forget that they have for many years maintained

the principle that the examiners should, as far as possible,be separate and distinct from the Council, and seven years

ago the Council recognised the value of this principle ina resolution that not more than one-half of the examiners

should in future be members of the Council. Unfortunately,they have departed in practice from their profession, for as

things now stand Mr. SAVORY and Mr. HoLMES are the onlymembers of the Court of Examiners who have not a seat in.

the Council and if one or both are now elected to the

Council the operation of this salutary measure will be entirely. defeated. If this principle was worth fighting for, it is worth! preserving, and should not, therefore, be needlessly sacrificedto mistaken sentiment and good-feeling. The examiners

are accounted responsible to the Council, but if all the ex-L aminers are also members of the Council they become prac-tically irresponsible. Further, in questions of appeal fromI the Court of Examiners to the Council they would become, the judges of their own cause.t A word may not be out of place here on the method ofF voting. Every Fellow has as many votes as there are

- vacancies. On Thursday next three members of the Councilf are to be elected, and the Fellows should therefore vote fori three candidates, and discountenance the pernicious systemof " plumping " so often resorted to in order to secure the

election of a feeble friend. The electors should not forgeto that they are entrusted with the right and privilege of theo vote, not for themselves only, but for the thousands Q1

943THE UNIVERSITY OF LONDON AND MEDICAL WOMEN.

Members whose interests are necessarily identified with both in the metropolis and our large provincial towns, whothose of their College. Plumping is not only vicious and signed the protest against the action of the Senate. Did

degrading in principle, but unjust and subdolous in practice. the medical senators who favoured the admission of women

We trust, therefore, that it may not be necessary next week point out to the lay senators these truths ? Did they into record a single plump vote. the plainest possible language, as their duty was, declare

that the vast body of the memorialists were not, could not,be influenced by selfish or-we are reluctant to write the

THE Senate of the University of London, as we reported phrase—trades.unionist motives ? We say, without hesita-

last week, has, by a majority of sixteen to eleven, refused to tion, that it was their duty to do all this. We feel com-

postpone the question of the admission of women to its pelled to go further, and to condemn the action taken bymedical degrees. In the minority we find the names of Sir WILLIAM GULL, Sir JAMES PAGET, and Mr. Busg. It

men of the highest distinction both in the medical and was their votes which turned the tide against the opinionother worlds, and who cannot have been influenced by any of those to whom the University owes much of its renown.of those narrow prejudices which have been asserted to be It should not be forgotten that the University did not make-a special peculiarity amongst members of the medical pro- the fame of the medical graduates, but the medical graduatesfession. The minority consisted of Lord CARDwELL, the the medical fame of the University.Dean of LINCOLN, Mr. JULIAN GOLDSMID, Mr. FOWLER, Under ali these circumstances was Sir W. GULL justified inLord ACTON, Sir WILLIAM JENNER, Dr. QuAiN, Dr. voting against the great weight of the medical graduates ? STORRAR, Dr. SHARPEY, Dr. GEORGE JoHNSON, and the late Our answer is, he certainly was not. As to Sir JAMES

President of the College of Physicians, Sir GEORGE BURROWS. PAGET and Mr. BUSK, whom, with Sir WILLIAM GULL, weThus six medical members voted against the admission of hold in high respect, their votes are still less justifiable.women, and of these five are medical graduates of the Let them put the College of Surgeons in the place of the

University of London. On the other side, besides the University of London; would they not in its case, similarlyChancellor (who is a convert of recent date), the Vice- placed, have complained, had the votes of medical men notChancellor, and Mr. LowE, Mr. GoscHEN put in an appear- Fellows of the College prevented the fulfilment of their

nnce, though he can scarcely claim to have taken much views as to the admission of women for the Collegeinterest in the affairs of the University previously. Three diploma ? We venture to say that not one of the

medical senators voted for the admission of women-Sir medical graduates of the University of London on theJAMES PAGET, Mr. BUSK, and Sir WILLIAM GuLL, the last- list of its Senate would have deemed it his duty tonamed only being a graduate of the University. This take an active part in the converse case which we have

analysis of the voting is sufficient to show how the result put. The three medical senators who voted against thewas arrived at. As far as the medical senators (who are medical graduates of the University, Convocation, andlikewise graduates) are concerned, the majority against the the majority of the medical senators, may fairly claim toadmission of women is as five to one, and of those medical have acted on the high grounds of justice. But it would

senators, not graduates, Sir GEORGE BURROWS’ vote may be easy enough to undermine such grounds. Justice does

certainly be considered as equal in value to that of Sir JAMES not enter into the case at all in reality. The medical

PAGET. Taking into consideration the vote of Convocation in women of the country already have their school and

xegard to this question-a deliberate vote, perhaps the most an examining body willing to qualify them for the

deliberate ever given in Convocation since its institution ; practice of medicine in accordance with the law ; and

.and, further, the memorial of the medical graduates, therefore the present question might prudently have beensigned by 230 of their number within the space of a deferred until the larger question of admitting women toweek or ten days, and certainly, if opportunity offered, degrees in all the Faculties had been determined. The

likely to be signed by many more,-it seems monstrous that University of London further is peculiarly constituted,the Senate of the University of London should have, at its and its charter expressly states that the Senate shall have

.adjourned meeting, at once resolved to pursue its previous no power to make an alteration in such charter without

policy. It refuses to listen to its medical senators, its the consent of Convocation. The greatest possible changemedical graduates, and to Convocation, whose decisions it has been made in the constitution of the University byhas been quick enough to quote in less difficult questions. the Senate against the declared wish of the Convocation.Did the supporters of the admission of women analyse Is it too late to ask the Senate to pause ? Is it too late

carefully the memorial of the medical graduates ? Did to ask those medical members who voted in the majoritythey realise the fact that amongst the signatures were to listen to the voice of the profession generally ? Wethose of men holding leading positions in all branches have written warmly on the whole subject, but we are

of medical science, and of men who were teaching or had quite sure that those-whether medical or non-medical-who

taught in one or other of the medical schools of London ? are acquainted with the question in all its phases, and haveThe memorial was a silent protest against the action of the weighed it in a fair balance, will agree with us that the,Senate, but certainly worthy of the consideration of that University of London has committed a grave error. The

body, and especially of those who voted lately in the history of the whole transaction of the admission of

majority. It was not only teachers in the schools of women to its medical degrees is one which all right-London, but teachers in the schools of the United Kingdom, minded men and women must regret, and the transactionand men occupying private positions indisputably good itself is likely to prove a source of pain to society gene-

944 LUNATICS OUT OF ASYLUMS.

rally, and of detriment and deterioration to the University the patient. If the Legislature can be brought to see

itself. where the sting of the obligation is located, it may be

extracted. Why insist on a certificate being given ? 2 When

BEYOND doubt, many cases of lunacy may be successfully it is known that cases are kept in holes and corners out oftreated without removal to an asylum. The practice of sight., and denied the chances of treatment, chiefly to avoidthus dealing with patients labouring under the more acute the incubus of a certificate of lunacy, policy, if not pru-forms of " mental disease" will probably increase as it dence, must surely suggest the waiving of an idle form.comes to be recognised that insanity is a malady within the The remedy is not far to reach. Make the duty of reportingrange of the ordinary medical art. It is, therefore, in the any and every case of mental disability obligatory, and on

highest degree important that measures should be taken to the basis of that report, without requiring formal classifica-secure for the victims of mind-derangement the legal pro- tion by certificate or inquisition, institute a system of visita-tection their peculiar position requires. It is intolerable tion which shall secure proper care. We believe this con-

that, under cover of family affection, a helpless person cession, small as it may seem, would remove the bulk of theshould be kept in a condition injurious to health and difficulty about registration. It is of course essential to the

offensive to the instincts of humanity; nevertheless, as the success of such a measure that the registration on reportlaw now stands, there is no power to remove an insane shall not create any legal disability. It must be barred as a

patient, not supported by the rates, out of the custody of plea in law for the purposes of the Lunacy Acts. This re-

his or her so-called "natural guardians." The circumstances servation could be readily made, and would leave the legalmust be exceptional indeed which would, as the law stands, question just where it now rests, while securing the safe-justify magisterial interference, and fear of failure in the guard of supervision for the dependent patient, whether saneattempt to help a patient badly placed probably deters or insane in the eyes of the Law.

action in cases where the step could be justified and might Sooner or later this Gordian knot of the lunacy question,succeed. We have no desire to express an opinion on the in which two totally distinct matters have been vexatiouslymerits of any particular instance of alleged neglect. It is entangled, must be cut by the abolition of medical certificatesalways difficult to determine the amount of blame attaching carrying civil consequences. It is essential that the insane

to those in charge of a lunatic, even when the appearance of should be placed promptly and effectually under treatment,the patient is discreditable. It may be true that efforts have whether in their own homes or in asylums. The process of

been made to secure cleanliness and suitable surroundings, certification acts as a serious drawback to the chances of

and the failure may be due to conditions which the friends cure. Cases which ought to be sent to special institutions forare unable to control. This remark will not, of course, the insane are kept at home because the friends hope againstapply to the practice of placing what are known as " dirty" hope for recovery, and will not incur the penalty of legalpatients in unfurnished rooms, or neglecting to supply disfranchisement for the patient until the chances of speedythem with suitable clothing. There is, however, much to recovery are exhausted. Probably half the "single patients"be said in explanation of circumstances which at first sight scattered over the country, with no protection-unless theseem to admit of no excuse. It is only fair to make this re- estate happens to be under the jurisdiction of the Court ofservation and give the utmost weight to all it implies; never- Chancery, are kept out of asylums to avoid the stigma of £

theless, we contend, the condition of law which does not lunacy being fixed on the patient and his friends. Few

insist on the registration of every case of lunacy is unsatis- patients are retained in private families to save expense.factory and full of peril. Those who fall under the last-mentioned description need t.

Objections of diverse character have been raised to the be closely watched. The time has come when the positionproposal that " single patients," as they are technically of these pitiable objects-the victims of cupidity, or of thecalled, should be placed under the jurisdiction of com- dread of exposure and legal disability-should be placedmissioners. It has been alleged that no ingenuity would be under protection. Direct inspection by the Commissionerseffectual to discover these cases, and nothing short of an in Lunacy may not be necessary. Medical officers of health

army of inspectors could suffice to keep them under super- might be armed with special powers as agents of the Lunacyvision. No difficulty should be allowed to count as an excuse Board, or subordinate officials acting under the Lord

for the neglect of necessary public precautions. We are, Chancellor’s Visitors of Lunatics. It would be essential to

however, strongly of opinion that the obstacles to a system require a proof of acquaintance with mental disease, but noof registration and inspection are not insurmountable. The great difficulty should be experienced in inducing medicalpreliminary objection urged by the friends of lunatics, who officers to qualify for these additional duties if they werecan be treated out of an asylum, is founded on a not un- suitably remunerated. Whatever preliminary difficulties

natural desire to keep the case secret. This is a lingering may beset the organisation of a system by which " singleshade of the old prejudice, which regarded insanity as in patients " can be provided with the security their conditionsome degree discreditable to the family in which it occurred. demands should be surmounted. The need is pressing, andTime alone can remove the misconception that 11 the blood the obstacles to its full satisfaction are neither so great normust be tainted" when a member of the house becomes "de- so numerous as they have been too persistently represented.ranged." Sifted to the bottom, the objection in its present form is not so much a fear of consequences, as a dread of SINCE the Premier left that arena of debate in which he had

exposure. The danger lurks in the process of certifying, worked so actively for more than half a century, and took hiswhich is the initial step to obtaining legal protection for seat in a more exalted place, the public have heard little or

945THE PRE5TlEP. ON HEALTHY HOUSES.

nothing of Lord BEACONSFIELD’S opinions on current topicsof the day, either in or out of the Houses of Parliament.Though still at hand to influence the counsels, and directthe action of his colleagues, this almost total absence of

speechmaking has been specially noticeable, and the openingof the Victoria Dwellings Association by his lordship on

Saturday afternoon last was an ordinary event that thisspecial circumstance made unusually interesting. The

Association, which appears to possess a large number of well-known and very distinguished men among its supporters, isformed upon the plan of one constituted under the auspicesof Sir SYDNEY WATERLOw, the object of both being to

provide healthy homes for artisans and labourers. The first

block of buildings is situated near Battersea-park, and abrilliant gathering assembled last week to celebrate the

opening thereof. Mr. J. WALTER, M.P., the Chairman ofthe Committee, and a very active promoter of the movement,reminded his audience, in an introductory address, that

although London is the healthiest capital in the world, itsmortality not exceeding 23 or 24 per 1000 per annum, themortality in certain districts ranges from 40 to 60 per 1000,"that mortality being referable to the filth and foul air

which produced disease." He adverted to the fact that the

population of the metropolis was increasing at the rate of40,000 a year, while all that had been done by all thesocieties to provide improved dwellings of this class wouldaccommodate less than 40,000 persons. It was a mistake to

suppose that London was a densely populated place, but itwas an undenia’ale fact that, despite suburban houses and

cheap railway fares, the London artisan and labourer mustlive near their work.

The Earl of BEACONSFiBLD, who followed Mr. WALTER,and whose speech of course constituted the "event" of the

meeting, proved to his hearers that Mr. DISRAELI’S

rhetorical armour had not got rusty from want of use. It

was a happy thought of the promoters of this Associa-

tion to secure the aid of the Premier, who is never so

successfully engaged as in advocating a cause that is or

should be popular with patrician and plebeian alike. His

lordship’s speech, as heard had the old ring of terseness and

perspicuity, and those genial illustrations of cause and con-sequence which we are accustomed to connect with the

Premier’s happiest efforts. Lord BEACONSFIELD told his

audience that 11 the man who feels that his home is ‘home,sweet home,’ is proud of the community in which he dwells;but the man who feels that his home is a den of misery andPrime immediately a8sails that society of which he believeshimself to be the unjust victim." And farther on: " The

health of the people is really the foundation upon which alltheir power and all their happiness as a state depend." These

are statements pregnant with profound importance, as comingfrom the lips of the Prime Minister of England, who says,moreover, towards the conclusion of a very able and eloquentspeech, " The health of the people is therefore, in my

opinion, the first duty of a statesman." Such being thecase, it is competent for us-indeed, it is a duty incumbenton us-to ask how Mr. DISRAELI, in the House of Commons,and the Earl of BEACONSFIELD, in the House of Lords, hasfulfilled this "first duty." Has the health of the peoplebeen made a prominent subject for legislation during the

past three years ? We think not. Conservatives will point,among other measures, to the Public Health Act of

1875, to the Artisans’ Dwellings Act, and to the Foodand Drugs Act. But the first was purely a measure ofconsolidation; the second is undoubtedly useful, but verypartial in its operation; and the third can hardly becalled a "people’s Act," because all classes are by its

provisions benefited alike. We are, to use official language,"harassed" and "worried" on many sides by accounts ofthe spread of epidemic diseases, the inevitable result of

defective sanitary administration, inaugurated by Mr. STANS-FELD, and perpetuated by his successor. But who, we mayask, is personally responsible for the suppression of the postof medical officer to the Privy Council and the 11 cheese-paring" operations that occurred in the Medical Departmentof the Local Government Board on the retirement of Mr.

SiMON ? P The Artisans’ Dwellings Act is as much concernedwith the destruction as with the reconstruction of dwell-

ings, and concerns, as we have already indicated, com-paratively limited areas. But houses can still be built, andare being built, all over the kingdom, not only in the metro-polis, but in urban and rural districts, with no properlyconstructed feundations, no systematic water-supply, and nodrainage or sewer arrangements whatever. It is, indeed,within our knowledge that in many cases powers have bee.asked from the Local Government Board to stop the erectionof houses until certain sanitary conditions have been com-plied with, and the Board has refused to grant them.THE LANCET, as all our readers know, is not a political

journal. But" Sanitas, sanitatum," was the cry of the presentparty when it entered office, and it is astounding to us that,with the experiences of the immediate past, the Premierstill repeats that cry with pristine emphasis and vigour.Mr. WALTER and the managing committee of the Victoria.

Dwellings Association are, in company with Mr. PEA]BODYSexecutors and Sir SYDNEY WATERLOW’S Company, doingmuch to improve the condition of the artisans and labourerswho earn their living in London. But it is eminently un-satisfactory that the present Prime Minister, having beensecured on this occasion to advocate a cause supported by allshades of politicians, should show, after three years of

office, results so scanty, although his lordship still declares

emphatically that "the health of the people is the first dutyof a statesman."

Annotations." Ne equid nimis."

THE MEDICAL RECISTER.

PRECISELY four years have elapsed since we drew atten-tion (and then very mildly) to the general inaccuracy of £that important document called the " Medical Register."It is now an official record of very great importance. The27th see. of the Medical Act requires the Medical Council topoint" correct register" year by year. This book is,therefore, bought, read, and relied upon by the authorities at

the Admiralty, War Office, Home Office, B ard of Trade,Local Government Board, and other departments, a,9 givingaccurate information as to who is, and who is not, a "regis-tered medical practitioner." All our readers are aware,