BMJ

Provincial PhysiciansAuthor(s): MedicusSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 7, No. 177(Feb. 17, 1844), pp. 395-396Published by: BMJStable URL: http://www.jstor.org/stable/25492669 .

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PROVINCIAL PHYSICIANS. 395 irregular feel, insensible to the touch, and growing from the whole circumference of the os uteri; it had less of the granulated feel than the cauliflower ex crescence usually has, having a striated form, giving the idea of a bundle of small vessels connected together.

Dr. Ingleby saw her with Mr. Elkington, and pro posed the excision of the cervix uteri. She refused to have the operation performed, and gradually got

worse, the floodings each time leaving her more ex hausted. During the last fortnight she had almost constant vomiting. The evening before she died she took some warmed ale with ginger, and soon after

wards was attacked with violent spasmodic pain at the stomach. She continued in violent pain till she died.

Post-mortem Examination Dec. 7.

General Aspect.-Great emaciation; exsanguine ous; cedema of the legs, &c.

Chest.-Slight adhesions; considerable effusion; lungs healthy; heart pale and flabby.

Abdomen.-Effusion; great paleness of the viscera; liver pale and soft; there was a laceration of the stomach, about an inch and a half in length, recent in its appearance, and which must have taken place just before death; there was no evidence of inflam

mation in any of the surrounding parts. Uterus.-Slight deposit at the fundus, also at the

cervix of brain-like fungus, with some change of structure. The tumor very much shrunk, soft, and

brain-like-pulpy. MR. CARTER'S CASE OF MALIGNANT DISEASE OF THE

WOMB.

Mr. Carter then presented to the society a fine specimen of fungoid disease affecting the fundus, and forming a large tumor upon the anterior part of the uterus, softened in its interior and communicating with the cavity of the uterus.

It was taken from the body of Mary Ann Bishop, aged forty-seven, the mother of seven children, the youngest three years old. She was of a strong, robust habit; had been healthy, except an occasional cough, until about October, 1842, at which time she

began to experience symptoms similar to those of

pregnancy, which continued until Christmas, when she received an injury to her leg and foot, which

was immediately followed by uterine hemorrhage, from which she was still suffering when Mr. Carter

commenced attending her. January 14, 1843. She complained of severe pain

in the loins and pelvic region; pain in the chest,

difficulty of breathing, and cough; in a few weeks

she passed a very large quantity of hydatids from the

uterus; the flooding continued more or less up to the

period of her death. She had at times very severe

pain in the bowels, with diarrhea; a few months

before her death the expectoration was mixed with

blood. She continued to get worse, and died on the

19th of December 1843. Post-mortem Examination, Twenty-four Hours qfter

Death.

Body not much emaciated, nor decomposed. Head not examined.

Chest.- Adhesions of the pleura, and fungoid disease very extensively deposited in the tissue of the lungs. Heart healthy.

Abdomen.-Fungoid deposits in the liver, spleen, and pancreas, and in the mesenteric glands. Stomach

and intestines healthy. Fungoid deposits in the kidneys, and in the uterns,

as before described. Ovaries healthy.

PROVINCIAL PHYSICIANS.

TO THE EDITORS OF THE PROVINCIAL MEDICAL

JOURNAL.

GENTLEMEN,-The physicians of England uncon nected with the London College, but graduates of

Edinburgh, Dublin, Glasgow, Paris, and Berlin, con

stitute a body in every way deserving of public

respect, and capable of exerting considerable par

liamentary influence-a body, as I believe, much

exceeding the London College in numbers, almost all

whose members are in extensive practice, and possess the confidence of a very large and very intellectual

portion of the people; and yet, notwithstanding so

many advantages, these educated and intelligent men

remain in a state of lethargy at a critical moment,

when measures are about to be brought forward in

Parliament which will most seriously, or, rather, most

insultingly, affect their position. It is supposed, indeed, that the new charter and the

new bill will not actually disqualify them-will not

render it illegal that they should practise. Oh, no!

they are to be tolerated; but all persons desirous of

entering into practice as physicians, after the date of

the bill, will be compelled, by its stringent enactments, to belong to the London College.

THE TOLERATED CLASS, unless some measures of

defence be quickly taken, will be exposed to the

annoyance of being looked down upon, not only by

the present members of the London College, but by its rising generation--by those who are at this

moment boys at school, or babies in the nursery.

Now, there are many members of Parliament who

are ready to help the graduates of Edinburgh, Dublin,

Glasgow, &c.; but these graduates must first help themselves, advance their claims, and rouse them

selves into active exertion.

The charter and bill should be postponed indefi

nitely, or the following clauses should be introduced into them:-1st, that every graduate of Edinburgh,

Dublin, Glasgow, Paris, and Berlin, who may have

been three years in practice as a physician in any

part of England, shall be entitled to register himself

as a licentiate of the London College on the payment

of ?5 or ?10 into the college treasury; 2nd, that no

stamp be required for the licenses. The latter clause

is perfectly reasonable, inasmuch as most of the

gentlemen to whom it refers have already paid to the

government astamp-duty on a medical degree. These clauses would bring a large sum into the college, and

would place the president of that institution at the

head of an united, numerous, and truly influential

body, comprising all the physicians of England. A committee should at once be organised, including

all interested parties who reside in the metropolis, or

at a distance not exceeding thirty miles; the meetings of the committee should be held twice weekly until the

bill and charter have been disposed of; the proceed

ings should be characterised by the most determined

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396 REPLY TO A LINCOLNSHIRE VICAR.

*perseverance, but by the most courteous language and demeanour; not a word should be uttered that

could give offence to the most irritable and unreason

able of our opponents. The committee should resemble "a committee of the whole house," to use parlia.

mentary language, that is, provincial physicians coming to town from the more remote districts should be entitled to sit and vote.

Some steps have been already taken towards the formation of such a committee; but the difficulty of communicating with physicians at a distance is by no means trifling, and the number of gentlemen interested is much greater in the country than in town. I have,

therefore, Gentlemen, availed myself of your excel lent periodical, using it as a means of communication, in the hope that provincial physicians may, on this

question, start into energetic and continuous activity -an activity, however devoid of acerbity or

coarseness.

I have the honor to be, Gentlemen,

Your obedient servant,

MEDICUS.

Feb. 10, 1844.

EACH PROFESSION REQUIRES A DISTINCT SURVEILLANCE.

By A SOMERSETSHIRE M.D.

TO THE EDITORS OF THE PROVINCIAL MEDICAL JOURNAL.

GENTLEMEN,-In reply to the "rambling" letter of your Lincolnshire Vicar, I beg first to observe

that the publication of unprofessional letters in your medical journal is not likely to be very palatable to

the majority of your readers, not only causing a waste of time on their part, but likewise a waste of paper in your columns. Your correspondent professes to " have made few advances with the rapid progress of the

present intellectual age," and, as a natural sequence, ridicules all innovations. To show the incorrectness of his conclusion, I would merely remark that the

" last thirty years " have made a very great change in

the general education of the people, and if the mass

then spoke incorrectly from ignorance, they have not that plea to offer at present for their partiality to

"old-fashioned " notions. As well might the courtiers

of the age of Queen Elizabeth vaunt of the elegance of their style and the correctness of their diction, and

pronounce the present state of affairs to be but " horrid

barbarisms," as the " Lincolnshire Vicar " to bewail

the loss of his favorite "spatterdashes" for the

classical term " antigropelos." That the reverend

gentleman should complain of "anomalies" in our

profession is far from remarkable, as we entertain

precisely the same idea with regard to his own; but

we do not venture to pass critiques on the church, or

entangle ourselves in theological tenets, for the

simple reason that we think each profession has quite

enough to do to reform itself, and that, therefore, each profession requires a distinct surveillance.

If the " Lincolnshire Vicar" will look at home, he

will find quite enough "to cause no little astonish

ment, and sometimes no little mirth." * * * *

But we forbear, and turn to his crude ideas of physi cians and apothecaries. Thirty years ago the line of

demarcation between an M.D. and a general practi tioner was much more strongly drawn than at present; then the finely powdered wig, the court cut coat, the

gold headed cane, and the silver buckles were added to his external appearance, then the portentous shake of the head boded all manner of omens, then apothe

caries approached their presence with awe and

trembling, and then a momentous silence sufficed their patients for troublesome explanations. Those

were the golden days of Galen's sons; but now, like

the class of the "old English gentlemen," the physi

cians motto must be-fuimus. The vicar's rusticity

must, therefore, alone account for his ignorance of

the above, as he, poor soul, innocently asks, " are

doctors getting up?" Still, however, there is a dif

ference of rank between the above mentioned classes,

admitted by society at large, as well as by professional

etiquette, similar to that accorded between a barrister

and an attorney, a rector and a curate. The pre

cedence of the first arises from the following causes :

The regular bred physicians are, for the most part,

sons of gentlemen, they receive a collegiate education, travel for professional information, attend the schools of Paris, Berlin, or Vienna. They read the new

publications, so as to keep up with the spirit of the

times, since the science of medicine is one of progres sive improvement. They study general literature, are versed in the arts and sciences, and, at an age

much maturer than that of the clergyman, to whom

the cure of souls is intrusted, they return to devote their time and talents, enriched by accumulated facts

and observations, to the alleviation of human misery,

often for many years without any remuneration, than the satisfaction of an approving conscience.

Now, let us turn to the case of a general practi tioner. Apprenticed at an early age, either to a

surgeon or an apothecary, for the term of three or

five years, more than the half of which time is spent in performing services wholly irrelevant either to his situation or education, with perhaps slender means,

and still less time at his command, how can it be ex

pected that he should devote himself to the completion

of his classical studies, or the acquirement of elegant

literature, &c. ?-and often, at the expiration of his

term, he finds himself obliged to accept an assistant's

situation, with a salary of perhaps ?20 per annum,

and duties requiring ?100. Can it, then, be reason

ably entertained that he will lay aside his professional avocations to improve the imperfect state of his

medical knowledge ? No. Therefore the education

of the one will not allow him to vie with the superior

opportunities of the other; and I think the reverend

gentleman will acquiesce in my conclusion that the

physician is, therefore, entitled to precedence. If your clerical correspondent had ever visited

London, he would have remarked that physicians are

the favored set, both at court and among the higher and wealthier classes. He would there have found

"phenomenon the first of our medical horizon" often

repeated, as several of the most popular and rising

physicians of the day plead guilty to being young in

years; and, indeed, if a general practitioner is entitled

to confidence at twenty-five years of age, surely a

physician may claim the same indulgence at thirty

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