489

THE LANCET.

LONDON: SATURDAY, APRIL 20, 1867.

PROGRESS AT THE COLLEGE OF .SURGEONS.

iWE are happy to have to record a progressive step on the

,part of the Council of the College of Surgeons with regard tothe question of extending the examination for its diploma toMedicine and the allied sciences. Our readers are alreadyaware that negotiations have for some time been going onbetween the College of Physicians and the College of Surgeonswith a view to the formation of one examining board for thegranting of a double qualification; and though this has been I

found unfortunately to be impracticable in the present state ofthe charters of the two institutions, the result which has beenarrived at is a decided step in advance, and one which mayin time lead to yet greater improvements.The Council of the College of Surgeons received the report

of its committee on Friday the 12th inst., and has determinedthat candidates for its diploma must (after a certain date tobe announced) either produce evidence of having passed someexamination in Medicine, or submit to an examination by aboard of examiners in Medicine to be appointed hereafter, IThat this regulation may not, however, press hardly upon thestudent who, having been working diligently at Surgery, isanxious to present himself immediately for examination, it hasbeen resolved that he shall be allowed to present himself forthe surgical examination at his option; but if he elect to post-pone his medical examination, his diploma will not be availableuntil that ordeal is passed. The College of Physicians is ex-pected to reciprocate in the arrangement by abolishing its

separate examination in Anatomy and Physiology for thosewho have’ already passed in those subjects at the College ofSurgeons, and will thus be able to devote more attention toMateria Medica and Therapeutics, and Chemistry. Whether

the College of Physicians will still retain examiners in Surgerydoes not appear to be definitely settled.Thus it will be observed that the diploma of the College of

Surgeons can in no sense be termed a double qualification,any more than the licence of the College of Physicians. The

latter never conferred the legal privilege of more than onequalification, though the examination embraced the subjectof Surgery; and the former will not do any more, though itembrace the subject of Medicine. It is no slight advantage,however, to the profession and to the public to have the know-ledge of members of the College of Surgeons more extensivelytested than heretofore ; and it is satisfactory to find that thenew arrangement, so far from pressing hardly upon the student,will tend to lighten his labours by obviating the necessitywhich now obtains of his passing again and again in the samepreliminary subjects.The question of fees will perhaps require some little adjust-

ment, since it is obvious that in the majority of cases the costof the College of Surgeons’ diploma will be increased, althoughthe candidate will eventually be in the possession of a diplomaqualifying specially in both Medicine and Surgery. We fear

that on the score of cheapness the Apothecaries’ Hall will beapt to be regarded with favour, and should not be surprised:ifthat tottering institution should take a new lease of life inconsequence.Whilst such enlargement is being made in the scope of the

examination for the Membership, it appears not unreasonableto inquire what is to be done about the-Fellowship *? Althoughnot numerous, there are Fellows of the College who have neverpassed the membership examination; and we cannot but thinkthat their number will increase unless some advance be made

in the standard of that examination. The examination for

the higher grade at the College of Physicians includes onlymedical subjects, and it may be that that for the c-orrespon(:I-ing rank at the College of Surgeons should include only sur-gical matters ; but if so, the present style of the examinationrequires revision, and at least the anatoniical portion of ’itshould be more searching than for the membership, instead ofless so, as at present.

AT the Comitia Majora of the Royal College of Physicians,held on Monday last, there was an extraordinarily numerousattendance of Fellows, no less than eighty-four being present.This almost unexampled muster was due to -the interest

which was roused by the peculiar circumstances of the

election to the presidential chair. As we intimated in our

number of last week, the impending retirement .of Sir

THOMAS WATSON caused such strong regret that it was deter-mined to make one last effort to induce him to take office for

another year; and a meeting of the Fellows was called, an therequisition of some thirty of their number, and met on Friday,the 12th inst., at the College. Here, however, all further

action in this direction was barred by the reading of a privateletter from Sir THOMAS WATSON to the registrar, Dr. PITMAN,which expressed so strongly the absolute need of retirementand repose which the venerable President felt, that the reluc-tant conviction was forced upon the minds of all present thatit would be improper and-.ungenerous to press him any further.Under these circumstances, it became obvious that the electionof a new president would be an open event; for it was feltthat in filling up an office of such importance as the pre-sidency of the College every means should be taken to secureprecisely the best man amongst all those whose professionaland collegiate standing would enable them to occupy thepresidential chairwith dignity.The proceedings on Monday commenced by the admission

of three new members-of the College : these gentlemen were-FREDERICK SIMMS, M.B. Lond.; CHARLES GAINER, M.D. Pisa;and WILLIAM MATTERgox, M.D. St. Andrews. The admis-

sion of a batch of licentiates followed. Amidst deep silence,Sir THOMAS WATSON then rose to deliver his valedictoryaddress, which will be found at page 496. The deliveryof this address, in the President’s own inimitable language,and with all his natural earnestness.and sincerity, heightenedby his emotion at parting with the College, deeply affucted allpresent. Dr. BURROWS rose immediately on its conclusionto propose a special vote, expressing thanks to Sir THOMASWATSON for his conduct during the five years he had heldoffice, and the best wishes of the Fellows for his health andhappiness and long life-a vote which was received with loudand long-continued applause..

After this a very interesting episode occurred. A beau-

490 QUARANTINE AS A COMMERCIAL QUESTION.

tiful marble bust of the late Dr. JOHN CONOLLY had been cruel and permanent institution, and not to save the home

placed in the library, where it had attracted much notice. population. But, after all, this is an explanation which leavesThis work of art was confided to the care of the College everything to be explained. If it relieves the medical advisers

of Physicians by the Medico-Psychological Association, to of the Government from the responsibility of the blunderingwhich body it had been presented by the Baron MUNDY, a perversity which characterised the quarantine proceedings atdistinguished Austrian nobleman and physician, as a tribute Southampton, it does not modify that perversity in the leastof his admiration for the venerable reformer who did so much degree. It gives to it, indeed, if anything, rather a worseto improve the condition of the insane. On the present occa- aspect. Some justification might be pleaded, in the health in-sion, the Baron MUNDY, attended by Dr. HARRINGTON TUKE terest of the home population on a sudden emergency, for anand Dr. MAUDSLEY, the two sons-in-law of Dr. CONOLLY, undue stringency of quarantine and an insufficiency of meansformally presented the bust. Dr. TUKE, in a few words, to carry it properly out. But what justification can be shownexplained the circumstances under which the presentation for such insufficiency and stringency in the interest of com-was made; and the Baron MUNDY then, in a short speech, merce when the end sought to be avoided is one always exist-expressed the feelings of deep reverence for CONOLLY which ing, and which should, as a consequence, always be providedhad induced him to pay this tribute to his memory. While against ? The truth is, that the practice of the Government,congratulating England on the vast improvement that has whether considered medically or commercially, is utterly un-been effected in the treatment of the insane in this country, settled and without rule. In the recent instances at South-

he referred to the lamentable fact that the restraint system, ampton, at the outset, the measures of quarantine adoptedwith many of its worst evils, still flourishes in many parts of were as egregiously in error in reference to the requirements ofthe continent. And he said that a nobler sentiment could commerce as they were to the requirements of medicine. It is

hardly have been uttered than that which formed some of most earnestly to be desired that the requisites of quarantineCONOLLY’S last words-the expression of a wish that the only in the ports of this country should be taken under considers-line upon his monument might be this : "He founded the tion by the Government, and that a series of rules should benon-restraint system of treating the insane." Sir THOMAS formulated which, while meeting the health-needs of the homeWATSON responded in a few words of graceful thanks to population, would also obviate groundless fears on the part ofBaron MUNDY for the munificent and welcome present of an foreign maritime nations.object of art consecrated by so many ennobling remem- i And it is important also that the question of quarantine inbrances, and to the Medico-Psychological Association for the the colonies should be subjected to examination. The ab-

high compliment which it paid the College in confiding this surdest follies of sundry Mediterranean ports are burlesquedinteresting bust to its care. in some of our dependencies. Take the following cases inThe time had now come for the ballot, and the silver urn point:—A little while ago the Royal Mail Steamer Mersey

went round the room. In accordance with the practice of the arrived at St. Vincent from St. Thomas (where cholera

College, each Fellow simply wrote on a paper the name of the ! prevailed), bringing from England, as passengers, his Honourperson whose election he desired, and placed it folded in the Chief Justice TRAFFORD and three other gentlemen. Theyurn. The senior censor, Dr. GuY, then opened each of these were immediately placed in a sloop of 36 tons, which had beenpapers in succession, and read the names out, when it ap- chartered by the Governor, and stationed as a receiving vesselpeared that, of 84 votes, Dr. ALDERSON had obtained 57. in quarantine. Two days afterwards they were sent to a smallThis was one more than two-thirds of all the votes, and, in island, twelve miles from St. Vincent, out of the reach of allaccordance with the laws of the College, Dr. ALDERSON was medical care, and without an inquiry having being previouslydeclared elected president. He then assumed the chair, and instituted into the state of health of the party. While thusin a few words, which were received with acclamation, thanked isolated and away from all help, one of the gentlemen sickenedthe College for the honour done him. of what is believed, from the description of his companions,The only remaining business of importance was the election to have been yellow fever, and died. On the quarantine sloop

of an examiner in the room of the late Dr. BRINTON. The visiting the island, the survivors determined to return to

choice of the Fellows fell unanimously on Dr. JOHN WILLIAM St. Vincent, and complete their quarantine on board the vesselOGLE. in the harbour, then within reach of help. On their re-arrival

. in the port, another of the party was reported to be ill, and

THE English hygienist is apt to forget that quarantine is a a medical man was permitted to visit him. At a meeting ofcommercial as well as a medical question. He is prone to the Board of Health held about this time, the transferenceregard it in the latter aspect only, and liable to bewilderment of persons undergoing quarantine to an island out of the

in contemplating the wondrous manner in which it is often reach of assistance was condemned, as well as their confine-conducted by our own as well as foreign Governments. It will ment to a sloop in the harbour. It was also recommendedbe a relief to most medical men interested in the subject to that a building should be provided on shore, which could belearn from Lord R. MONTAGU, in answer to a question put by properly isolated and guarded. These recommendations do

Sir J. C. JERVOISE in the House of Commons on the ath inst., not appear to have been carried out. The health officer now

that the quarantine recently maintained against the West Indian for the first time was permitted to visit the sloop. He recom-

steamers at Southampton, and the quarantine arrangements of mended the liberation of the passengers ; but this recommenda-this country generally, "are not medical, but commercial." tion was not attended to, and they were compelled to ride cutIt was a quarantine, we learn, established mainly to exempt the prescribed fourteen days. The passengers petitioned theout-going ships from vexatious delays which otherwise might Governor; but he simply gave them the option of being trans-be imposed upon them in foreign ports, where quarantine is a ferred to a larger vessel, all costs to be defrayed hy themselves,

491THE CASE OF CHARLES ANDERSON.

and the vessel and crew to be subjected to quarantine. The gale of wind blowing about the time; and there appeared to benext mail by way of St. Thomas brought out to St. Vincent no doubt that he had committed the act under the impressionLieutenant-Colonel J. M. HAGGART, C.B. The Governor that if he did not kill the deceased both his own safety andinsisted upon this gentleman being subjected to quarantine, that of the crew would be endangered. Upon these facts,but refused at first to provide any vessel or locality in notwithstanding the charge of the learned judge, Mr. Baronwhich it might be undergone, giving permission, however, for CHANNELL, the jury found the accused guilty of wilful murder,the removal of the Colonel, at his own cost, to the island ignoring the suggestion of any unsoundness of mind, and,where the unfortunate passenger by the previous mail had therefore, withholding from the verdict any recommendationdied. Colonel HAGGART was compelled to be transhipped from to mercy.the steamer to a small craft of about two tons burden, which The learned judge accompanied the sentence of death withhad been formerly a ship’s long-boat, and in this vessel he re- such observations as leave little doubt as to the impression onmained a night and the greater part of a day. Permission was his own mind, even though he condemned the prisoner accord-then obtained for his removal to a fort, built on a sentinel ing to law. He observed " that the jury had found themselvesrock, a mile from the shore. compelled to convict the prisoner of the crime of wilful murder;

Surely the grievous and needless suffering to which British and as to the act itself, there was no doubt that he had com-subjects have been exposed by preposterous and unjust qua- mitted it. The defence set up was that at the time he was

rantine regulations at St. Vincent calls for the interference of labouring under a delusion which had compelled him to com-the supreme Government. No truth can be more unquestioned mit the crime, and that therefore he was not responsible. It

than this, that if a Government, local or otherwise, enforces a was not contended that he did not on ordinary occasions fullytemporary detention in the interest of a people, it is incumbent appreciate the difference between right and wrong, but it wasupon it to make all needful provision for the fitting shelter and said that he was labouring under a delusion, and that the

well-being of the detained. effect of this delusion was to induce him to commit the act.

The jury had carefully considered the matter, and they hadarrived at the conclusion that they were not justified, under

THE trial and conviction of CHARLES ANDERSON for murder the circumstances, in acquitting him on the ground of insanity,upon the high seas call for a few observations. The prisoner and it therefore became his duty to pass upon him the sentencewas rightly convicted of deliberately taking the life of JAMES of the law for the crime of murder. The prisoner bowed toMARCHIN, one of the crew of a ship, the Raby Castle, on her the judge, and was then removed.homeward voyage from Penang. The circumstances of the We have at times felt it to be our duty to stand betweencase were of an extraordinary character. The prisoner, on the convicted and the scaffold. On no occasion have we had

the 28th of September last, shipped in the vessel as an able less hesitation in so doing than on the present. "The exe-

seaman and carpenter. It appeared that during the voyage cution of an offender," writes Sir EDWARD COKE, "is for

he gave many manifestations of an eccentric though weak in- example; the execution of a madman would be a miserabletellect, of a perfectly harmless character. The deceased was spectacle, and one of extreme inhumanity and cruelty." There

a mulatto. The prisoner regarded him with apprehension, and are executions on record that would now be justly regardedwas said to be under a delusion that MARCHIN was a Russian as judicial murders. For once let this case have an analysis.Finn. It appears that there is some extraordinary superstition A man of good conduct, quiet disposition, manifesting no per-among sailors that the presence of a Russian Finn on board a sonal ill-feeling, is under a delusion that a certain person’svessel is likely to lead to the destruction of that vessel, to- presence will produce a particular fatal result. Circumstances

gether with the loss of the crew. The prisoner believed this. arise confirming him in his insane convictions. He acts uponHe was frequently heard to mutter to himself some incoherent his delusion as true, the delusion and the act being in directexpressions, to the effect that he could not go on in this conformity one with the other.way, and that he must kill the Russian Finn or they would Surely, to say that in such a case the knowledge of rightnever get to London. On no occasion had any personal and wrong, in reference to the legal relations of the act, is toquarrel arisen or ill-feeling been manifested between the pri- secure the execution of the offender, would be to postponesoner and the deceased. -Alatters continued to go on in the humanity to law, and entirely to ignore the teaching of expe-same manner, the delusion of the prisoner being well known rience. We have too much confidence in the wisdom and

to, and regarded in a good-humoured spirit by, his shipmates. righteous feeling of the experienced judge who tried the case toNo one anticipated the terrible result. During the night of anticipate for one moment that the law will be permitted to takethe 24th of November the prisoner had to watch on deck, its course. We write for a different object, considering thatand when free to act and unobserved he seems to have gone grave matter as already determined. The present legal test ofto the bunk where the unfortunate deceased man was lying, mental soundness is eminently fallacious. It begs the question itand attacked him with a carpenter’s axe, inflicting five des- is intended to settle, and seeks to reduce to a fixed standard theperate wounds upon his neck and shoulder, the effect of the varying and variable phases of disease. A knowledge of rightformer injuries being to nearly sever the head from the body. and wrong is possessed by the most dangerous inmates of ourThe prisoner was immediately suspected as the murderer. He lunatic asylums. A capability of discussing legal relations iswas seen to be wiping blood from his hands, and to throw an not an uncommon phase in ESQUIROL’S "reasoning madness."axe overboard. He was at once seized, and asked how he had Yet this is the test by which, in the solemn discharge of theircome to murder his comrade. The reply he made was that duties, juries are required by law to guide their convictions" if he had not done so the ship would have gone on the rocks, and to record their verdicts. If it be that a test of this nature,and they would all have been lost." There had been a heavy even though uncertain, is still deserving of being maintained,

492 SUDDEN DEATH AND MEDICAL DUTY.—GILCHRIST SCHOLARSHIPS.

let it be understood that, though legally sane, a man may bemorally irresponsible, and that that which the law sanctionshumanity may abhor. We trust that the Home Secretarywill direct some experienced psychological physician to exa-mine and report on this unhappy prisoner’s state, in order

.that the medical profession may, hy its protest against thesentence, be guiltless of his blood.

Medical Annotations." Ne quid nimis"

SUDDEN DEATH AND MEDICAL DUTY.

THE circumstances of the recent death of the late Bishop of I

Rochester, as explained in a letter to The Times of the 10thinst., suggest a question in medical casuistry which oftenarises in practice, and upon which therefore we may say a fewwords with advantage. The writer in The Times tells us thathis lordship had been informed last year hy his physician thatthe heart disease from which he suffered rendered him liableat- any moment to sudden death. The physician will doubtless,think that his prognosis has been fully justified. In takingthe course which he did of explaining to the patient the riskof sudden death he certainly only did what many other phy.-sicians do, and think it right to do. In our opinion, however,’the duty of a physician in these circumstances is not so easyas a.t first -sight it may appear. No doubt in heart diseasethere is a possibility of sudden death greater than obtains in imoat other diseases. But of two other facts there can also beno doubt. First, that in the great majority of cases of heart idisease death is not sudden ; and second, that in such cases ofdisease the tendency to early and rapid, if not sudden death, ’,is increased by the moral effect upon the patient of the fear of- sudden death which takes possession of him when its pos-.sibility is intimated to him by his medical adviser. It is im-

possible sometimes to say in any given case of heart diseasewhether death will be sudden or not. Often the suddennessof the event is a mere accident which is determined by an in-discreet exertion that should have been avoided, and but forwhich life, and useful life too, would have been long -pro-longed. In the case of the bishop this was probably the case.He had just before, with characteristic kindness, been helpingto convey a fainting friend up-stairs.Some medical men think that on the mere ground of a loud

bruit anywhere in the heart they may withdraw their stetho-scope and announce the probability of sudden death. Yetthis aninian is not onlv most unmerciful but is inconsistent

-with good pathology. The tendency to sudden death dependsnot so much on valvular disease as on the condition of themuscular tissue of the heart. Laeunec made this observation,and it has been abundantly confirmed by later authorities.Unprofessional people would be astonished if they knew howmany persons with noisy bruits in the heart go through a gooduseful life and come to as slow a death as other people. Someof the noisiest lesions of the heart are really the least important.What then is the duty of the physician in cases of heart dis-,ease ? We see little obligation upon him to go into detailed par-ticulars either of the nature of the lesion or of its possible modeof termination. All men are liable to sudden death, and it isthe duty of all men to take this risk into calculation. But

this is an injunction that should come rather from the clergy-man than from the physician, arising, as it does, out of moral-rather than medical considerations. Those with heart diseasedo not generally die suddenly, and it does not appear to usthat the good done by specifying the risk beforehand tothe exceptional few who die so will compensate for the evildone to them and to others by, as a rule, holding up the

! risk of sudden death in such cases. One great duty of thephysician is to make the best of impaired lives, of men whohave weak spots in their organisation, but who, nevertheless,! with care and good medical advice, may live long and well.*

A -great deal of the best work of the world is done by men.who would not pass the examination of a recruttiag surgeon--as the Country Parson would -say, by "screws." And ascheerful a prognosis as will consist with the probabilities of thecase is as much a duty of the physician as to advise the avoid-ance of unnecessary exertion. If any objector presses uswith the fact of the possibility -of sudden death, we retortupon. him the probability that death will not ;be sudden, andmaintain that our business in prognosis is with probabilitiesand the prolongation of life.

GILCHRIST SCHOLARSHIPS.

Two foundations of considerable value have lately been in.stituted by the trustees of the" Gilchrist Educational Trust,"founded by the late Dr.-Gilchrist, of the Indian Medical Ser-vice, which closely concern the members of the medical pro.fession, since they are specially open to young men intendingto graduate at the University of London in one of the fourfaculties of Arts, Laws, Science, or Medieine. The scholar-ships are each of the value of .S50 per annum, and are tenablefor three years. They will be awarded annually, providedthere are eligible candidates.One scholarship is, we are happy to say, in connexion with

the Royal Medical College at Epsom, at which institutionevery candidate must have been a student within the three

years immediately preceding the examination. Each candi-date must be approved by the head master in regard to hisgeneral conduct, and must be between the ages of sixteen andeighteen.

’ The second scholarship is in connexion with University Hall,Gordon-square, an institution founded in 1849 to provide a, place of residence under collegiate discipline for the students of’ University College. The same regulations as respects age and! the sanction of the principal of -the Hall .apply to this scholar-, ship as to the other; and scholars will be required to attend; at least three courses of lectures annually in University College,of which one must be in a modern language.

The election to both these scholarships will be decided bythe result of the Midsummer Matriculation Examination -of! the University of London, the scholarships being awarded to

the candidate from each institution who comes out highestat that examination, provided that he pass either in the"honours" or in the first division. Each scholar, on receivinghis half-yearly exhibition, will be expected to produce evidencethat he is pursuing a course of study with a view to graduationin the University of London, and will have to present himselffor the first examination in one of -the faculties -within two

years of his election, or forfeit his scholarship.I It will be seen, therefore, that the conditions of one scholar-ship are retrospective, and of the other altogetherprospective.Since many sons of medical men, intended themselves for themedical profession, are educated at Epsom, there will, we

imagine, be no dearth of candidates in that quarter; and theadvantages offered by the scholarship at University Hall aresufficient to draw many candidates. We arust to see both

scholarships gained by intending medical graduates, and caninform old Epsomians who have already entered at a medicalschool that this fact will prove no bar to their success, pro-1 vided they can comply with the regulations in other respects.! THE COST OF ZYMOTIC DISEASES.

I OrR Newcastle-on-Tyne correspondent, in his letter .this week, refers to the report of a sanitary commission appointed!. there by the Town Council ; and although it may be said that’ figures can be made to prove anything, it would be well for