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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