613

THE COMPULSORY VACCINATION ACT.

W. N. SPONG.

To the Editor of THE LANCET.SiR,—The vaccination question is now fairly before the pro-

fession. May I direct your attention to the following corre-spondence. I am, Sir,. your obedient servant,. W. N. SPONG.

Faversham, Kent, Dec. 1853.My LORD,-I am anxious to address you, as briefly as pos-

sible, upon the actual working of the Vaccination ExtensionAct in country districts. I have devoted some time to its con-sideration, and request your lordship’s attention to one or twopoints. I believe the medical profession as a body are in favourof the Act, and would do their utmost to carry it out, providedcertain alterations were made. Our grievances will be shownif I state my own case-an instance of thousands. I am inactive practice as a general practitioner, but have no parochialappointment as union medical officer, or contract as publicvaccinator. The better class of patients pay for this operation;but in every practice there are a certain number of poor, whoare unable so to do. If I vaccinate such, the law grants meno remuneration, and, as I refuse to do it gratuitously, theyapply elsewhere. The complaint with the public is, that itbears arbitrarily upon them, by compelling vaccination, andat the same time prevents them from having it performed bythose in whom they have most confidence—their own medicalattendants.

I assure your lordship that the Act would work much moreagreeably, both to the public and the profession, if everyqualified medical man was declared eligible for the appoint-ment of public vaccinator; the more especially if, in additionto this, the executive of the measure were placed under thecare and guidance of the Registrar-General, whose duties arealready intimately associated with questions of public hygiene.

I am your lordship’s obedient servant,Lord Lyttelton. V. N. SPONG.

Hagley, Stonrbridge, Dec. 1853.SIR,-From what I hear, the Act now in operation is doing

a great deal of good; but there is no question it was (neces-sarily being introduced by a private member of Parliament) animperfect measure, and it is possible that it may require someamendment next session. I doubt, however, whether anythingbut the power of the Government can pass such a Bill as maybe wanted; such points, for instance, as a due and constant

supply of lymph, a provision for seeing to the execution of theAct, including the prosecution of offenders, &c., are beyondthe reach of any Bill except it be introduced as a Governmentmeasure. I have, however, the strongest opinion that it ismost highly expedient, if not indispensable, that all qualifiedsurgeons should be allowed to contract, and I shall certainlyattempt to get that made general next session.With regard to the suggestion that the Poor-law should

have nothing to do with the subject, and that the Register-General should do it all, I can have no objection to that. The

register-office is one of the best of the public departments, andI feel personally indebted to its officers for the admirableforms and instructions which they have issued since my Billpassed. But this also is a point which must be left to theGovernment. I am your obedient servant,W. N. Spong, Esq. LYTTELTON.

SHOCK AFTER GUNSHOT WOUNDS.

[The following letter has been forwarded to us by Mr.Guthrie for publication.] ]

H.M.8. Arethusa, Besika Bay, Oct. 20, 1853.DEAR SiR,-Having had the opportunity of reading your

volume of Commentaries, through the thoughtfulness of SirWilliam Burnett in causing it to be supplied for the use ofthe medical officers of the Royal navy, I was so struck by thesuggestions and remarks at page 53, aphorism 47, respectingshock after severe wounds, as to render me desirous of report-ing to you a severe gunshot accident which occurred on boardthis ship.While the seamen were practising with ball-cartridge at a

target, a careless rear-rank man let off his musket, woundingthe front-rank man in the left thigh. He was brought offdeck immediately, bleeding most profusely. There was noshock, although there was a little faintness. His trousers werecut off at once, and pressure made on the pubis by an assistant-surgeon while I examined the wound. The ball had passedfrom behind downwards, forwards through the centre of thethigh, shattering the bone in the lower part of the upper

third into numerous pieces; on introducing the finger into thewound, it was felt to be in fragments. It being quite clearthat amputation must take place, he was left with the assistant-surgeon attending the artery while the instruments could begot ready. He was then brought down to the gun-room, andput on the edge of the table, supported by two men behind;the assistant-surgeon, above him on the table, was pressingthe artery on the pubis. The long knife was entered on theouter side just below the trochanter major, and carried acrossthe limb close to the bone, the other assistant-surgeon follow-ing it with his hands, grasping the flap which the knife cutoutwards. The flap was well turned up as soon as severed,and then the inferior flap was made; then the limb wassevered, as the bone was too much injured to hold it. Theend of the femur terminated in a point, which had to be sawnoff; in this piece of bone was the trochanter minor. Two

large vessels were in the anterior flap; they were found aboutits centre. Besides them, there were a great number ofvessels to be tied. The haemorrhage was inconsiderable, fromhe able way in which the artery was compressed, and inwhich the naps were seized after division. Numberless spiculaof bone had to be removed from the face of the flaps. The flapswere brought together with sutures, and covered with wet lint.Both shot-holes were left in the integument, as otherwise a goodcovering for the bone would not have been so easily made.

It is difficult to tell the lapse of time while so fully occupied,but I feel convinced from the time of his receiving the wounduntil he was in his cot and up on the main deck was underthree quarters of an hour. The limb was certainly amputatedunder the minute, for the time was taken. He was a littlefaint, bztt there was not any palpable s3eoc; indeed, so littlewas he faint, that he refused wine or any stimulant after theoperation. He had a full dose of morphia that night, slepttolerably, took a breakfast of tea and toast, and was landed atLisbon Hospital the next day. The wound healed withtolerable rapidity. The surgeon who had the charge of hiinoften spoke of the benefit which the shot-holes in the integu-ments afforded by allowing the discharge to escape freely.

I beg to conclude by stating that I have sincerely to thankyou for the benefit you have conferred upon naval medicalofficers by the publication of a book so full of instruction.

I am yours very faithfully,G. J. Guthrie, Esq. CHARLES DEANE STEEL, Surgeon.CHARLES DEANE STEEL, Surgeon.

AD EUNDEM DIPLOMA OF THE ROYAL COLLEGEOF SURGEONS OF ENGLAND.

EDM. BELFOUR.

To the Editor of THE LANCET.SiB,—In your reply to "lVI.R. C. S., in last week’s LAKCET,

respecting the licence in surgery and pharmacy from theFaculty of Physicians and Surgeons, Glasgow, you say, " Thesupposition that such certificates would entitle the possessor tothe diploma of the London College of Surgeons withoutexami)zation is an absurdity." I therefore beg to call yourattention to the resolutions of the Council on the 25th ofNovember, 1852 :-

" The licentiates of the Royal College of Surgeons in Ireland,of the Royal College of Surgeons of Edinburgh, and of theFaculty of Physicians and Surgeons of Glasgow, are admissibleto the membership of this College under the bye-laws relatingto ad eundem admissions."

cm

I also give you a copy of a letter received from Mr. Bel-four :-

"Royal College of Surgeons, Nov. 4,1853.SIR,-The enclosed will give you every information as to

your admission to this College without examination :-The ad eundena admission gives you the same rights as

admission by examination. The stamp is 208. on eitherdiploma. The ad eU/ldel1 diploma is granted by the Council;the other by the Court of Examiners.

I am, Sir, your obedient servant,EDM. BELFOUR." "

I shall feel obliged by your inserting this communication inthis week’s LANCET.-I am, Sir, yours obediently,

A LicF-NTIATE OF THE FACULTY OF PHYSICIANSAND SURGEONS, GLASGOW.

Market Drayton, Dec. 1853.

*** Our remarks applied to the certificates referred to by ourcorrespondent, and not to the licence of the Faculty; theopinion we expressed was therefore correct. In order to pre-vent any future misunderstanding, we reprint the regulationsreferring to ad eundum diplomas at the Royal College of Sur-geons of England, from the British Medical Directory"