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sister Lucy (to whom, on her seventeenth birthday, the novelist sent the verses, "Seventeen rosebuds in a ring") suggested at least some aspects of Ethel Newcome, the sweet and wayward-"my sister at that time going much into (American) society - she was not yet twenty, and had both wit and beauty. In his picture of Ethel Newcome, as she holds a little court about her at one of the great London balls, Thackeray reproduces some impressions made by the New York girl. Some of Ethel's impatience for the disillusions of society, its spiteful comment and harsh criticism, might well be reflections from discussions with my sister in the Brown House library, where Mr. Thackeray passed many an hour talking of matters grave and gay."

Finally comes Colonel Newcome, who, like Jos Sedley and James Binnie, was the outcome of the author's Anglo-Indian connections; like them he stepped out of the Oriental Club in Hanover Square. After visiting that institution when The Newcomes was appearing, a friend said to Thackeray, "I see where you got your Colonel." "To be sure you would," said the writer; "only I had to angelicise the old boys a little." It has been asserted by those who were acquainted with Thackeray's family circle that the character was taken from one or more of his relatives - from Major Carmichael Smyth, of the Ben

Chambers's Journal.

gal Engineers; or General Charles Carmichael, of the second European Bengal Light Cavalry (20th Hussars); or Colonel John Dowdeswell Shakespear. It matters little from which of these the preux chevalier was drawn. Thackeray was at his old school, the Charterhouse, on Founder's Day, 1854, when the idea struck him to make the Colonel a "Codd" (a colloquial term for a Poor Brother of the Charterhouse). He invited a boy with whom he was acquainted to introduce him to Captain Light, an old army man whom reduced circumstances had compelled to seek the shelter of Thomas Sutton's Hospital. Many times he went to see the veteran, who gleefully told all and sundry, "I'm sitting for Colonel Newcome." As readers of the book can never forget, the Colonel spent the last months of his life as a "Codd," and it was in that quiet retreat he drew his last breath. "At the usual evening hour the chapel bell began to toll, and Thomas Newcome's hands outside the bed feebly beat time. And just as the last bell struck, a peculiar sweet smile shone over his face, and he lifted up his head a little, and quickly said, "Adsum!" and fell back. It was the word we used at school, when names were called; and lo, he, whose heart was as that of a little child, had answered to his name, and stood in the presence of The Master."

Lewis Melville.

THE SURGEON'S POWER OF LIFE AND DEATH.

Gradually, progressively, almost imperceptibly, there has of recent years arisen in our midst a new tribunal, and one moreover of great power and farreaching influence; this tribunal is endowed with the power of deciding questions of life and death, and as at present constituted there is no appeal whatever from its decisions, which are practically immutable and irresistible. Directly a man, after a more or less prolonged and more or less successful course of study and hospital experience, becomes capable of writing behind his name the letters M.B., M.D., M.R.C.S, F.R.C.S., L.R.C.P., or other cognate qualifications, he is at once given, in a vast number of cases, the power of deciding whether a person who has consulted him shall be submitted or not to an operation, the ultimate effect of which may cost him his life, or leave him seriously maimed or incapacitated for life. This terrible power of life and death is thus placed in the hands of an inexperienced youth, practically without any safeguard whatever; for, after the operation is over, provided the patient dies, the operator merely requires to fill up a form of certificate, furnished by the State, in which there is stated the disease for which the operation has been performed, the nature of the operation more or less explicitly expressed, with the fatal result. There is an end of the matter. No inquiry is instituted as to whether (1) the diagnosis on which the operation was founded was correct, which it is frequently not, (2) the patient was in a fit state to undergo the operation with an expectation of a favorable result, (3) the operation was skilfully performed by an experienced operator, (4) every precaution was taken by the operator to give his pa

tient every possible chance of a successful result, (5) the patient as a result of the operation had a reasonable chance of being in a better position than he was before the operation if successful, i. e., whether as an individual he or she would be better fitted to carry on the functions of life in consequence of the operation having been performed.

Nothing whatever is done by the State in the interest of the patient, everything is left to the bona fides and. professional integrity of the operator, which it must be admitted is rarely abused, and the law, merely through the magic influence of the letters M.B., M.R.C.S., etc., etc., allows to remain uninvestigated a death which may have been caused by culpable ignorance, gross carelessness, want of adequate experience, or a host of other causes. which require careful searching out and inquiring into. In this description there is nothing exaggerated, nothing overstated, but merely a plain unvarnished exposition of facts which may be verified any day in any part of the country and which it is now time should receive the careful and deliberate attention of the State. In the case of a naval officer losing his ship, even though no loss of life is involved, he is court-martialled and a searching investigation is instituted to decide whether or not he is in any way culpable or responsible for the loss of or injury to his ship; again, when a military officer in command of men becomes involved in a disaster in which there is any loss of personnel or material, a more or less strict scrutiny is undertaken to prove that he has done what was humanly possible to avert or avoid the disaster; but in the case of the surgeon no such inquiry or investi

gation is made, and he may proceed on his happy-go-lucky way from one unsuccessful operation to another, secure in the consciousness that no inquiry into his conduct will be instituted, and that his professional conduct will not be in any way impugned, unless, in a very exceptional case, a blunder so transparent is made that an inquiry of some sort is bound to follow, as, for instance, when a forgetful surgeon leaves in the abdominal cavity, after a laparotomy, a sponge or a pair of forceps or two; even then, it is doubtful if any inquiry would be made in most cases, unless some very vigilant relative or friend should happen to learn of the event, and strenuously insist on the facts being brought to light. In consequence of the advent of the use of anæsthetics, the development in the use of antiseptics, and the perfect cleanliness which has resulted from the discoveries and observations of Lord Lister, many operations in surgery which were formerly quite inadmissible are now performed with almost absolute security and with undoubted and permanent benefit to the patient; for these legitimate operations nothing but the greatest admiration and praise can be expressed and felt, but as in all other human affairs there is nothing good and useful that has not its fraudulent imitations, so in surgery there has arisen a class of surgeons, mostly young, often inexperienced in other safer and more rational methods of treatment, and above all quite callous and indifferent to the true welfare of their patients, whom they look upon merely in the light of subjects to be experimented and operated upon. These surgeons, regardless of age or any other deterring considerations, have no hesitation in embittering the last moments of their patients by submitting them to what are practically hopeless operations, often under the specious plea of giving them a chance;

thus, what should be a peaceful deathbed scene becomes converted into a séance of operating surgeons, nurses et hoc genus omne, to whom the suffering patient is merely an interesting case. His obituary notice is another record in the case book of the operating surgeon, who, rightly from his point of view, has by constant repetition of such scenes quite obliterated the acute sense of humanity he originally possessed.

It may now perhaps be as well to investigate by what course of events we have arrived at our present position. Any educated and experienced practitioner of medicine will admit that in the past forty or fifty years the type of disease has been radically altered, so that the complaints and diseases which occurred in practice forty or fifty years ago were to a great extent quite different to what are met with at the present time. For instance, acute diseases such as gout, contagious fevers, small-pox, typhoid fever, etc., are incomparably less frequent than at the time mentioned. The explanation for this revolution in disease is simple and logical; in consequence of the more temperate use of stimulants, particularly of heavy wines and malt liquors, and more abstemious use of meats and solid viands of that nature, there is a distinct and unmistakable decline in the prevalence of gout and its consequences, such as apoplexy; the better understanding of the nature of contagious fevers and the sanitary precautions now universally adopted as a matter of course, have resulted in an extraordinary diminution in the number and even the severity of most contagious febrile disorders, and have reduced to infinitesimal proportions the deaths due to that appalling disease named puerperal fever, which was such a scourge to our progenitors, and which at the speed at which we are now progressing should in the near fu

ture become almost unknown; in the same category may be included septic complaints following operations, which are now few and far between, but which in the immediate past, say the period specified before, were of such a malignant quality that whole wards of hospitals were infected and decimated. The increased size and area of our living-rooms, the general recognition of the value of open bedroom windows and plenty of air space, the abolition of the notion that fresh pure air is unwholesome and that disease, especially of the respiratory organs, must be treated by respiring the same air again and again, which was held in the early part of the last century; all these have tended to the prolongation of human life, at any rate in these islands, and the average duration of life is now much greater than ever it has been known before to be since records have been kept. For instance, the deathrate in 33 of the largest English towns for the year ending 2nd January 1904 was in only one single instance, that of Liverpool, over 20 per thousand (20.4), whilst the lowest rate recorded for these towns in that year was that of Croydon, which stood at 11.8. A large town like Derby had only a death-rate of 13.5 per thousand, and there were no fewer than six of these 33 large towns which had a death-rate of under 15 per thousand.

Concurrently with this great and steady diminution in the death-rate of this country, there is an alteration in the type of disease, and with the reduction in acute, febrile and contagious diseases, as might be reasonably expected, there has been an increase in disease of a chronic nature, more especially in those of a degenerative character, such as malignant and innocent growths, and in nervous diseases. Again, in consequence of the progress of surgical knowledge many diseases of infancy which were formerly of a

fatal character are now successfully treated and these children are now reared, whereas till recently they would have died; the prevalence of children's Hospitals, children's wards in Infirmaries, district nurses and such like institutions have resulted in the fact that a delicate child's chance of being brought up is now immensely increased. Whether altogether this is a benefit to the community at large is another question which it is not my present intention to enlarge upon; the fact remains and is undeniable. Now this is the very class of individuals that is the most likely in after life to be afflicted with malignant and other growths and degenerative diseases; thus in consequence of this change in the type of the individual reared, and also in consequence of the progress of surgery, the introduction of anesthetics which render operations practically painless, and the adoption of antiseptic methods of treatment, which has rendered operations much safer, an enormous impetus has been given to operative surgery, so that it is quite safe to say that the number of operations in the last thirty years, even taking into consideration the increase of the population, has increased pro rata fourfold. This is as it should be; but now the time has come when the question of the personal responsibility of the operating surgeon should be considered seriously by the people at large. Operations may be divided into three classes: (1) legitimate and defensible, (2) illegitimate and indefensible, (3) those on the borderland between the two. We will now briefly consider these three classes.

I. Legitimate and defensible operations. Under this heading may be placed all those which give relief to pain, remove accessible growths, remove diseased, injured or useless members and organs-the scope of this article does not include surgical injuries.

In fact, any operation may be described as legitimate and defensible which is undertaken for the benefit of the individual without unduly risking his life, so that at the conclusion of the operation the patient is placed in a better position than he was prior to the operation having been performed.

2. Illegitimate and indefensible operations. In these the life of the patient is risked or shortened, and he or she is often put to vast pain, inconvenience and expense without any reasonable prospect of relief. It is notorious that many operations are performed as the result of a mistaken diagnosis, that cases of so-called appendicitis have been operated upon where the vermiform appendix has been found quite healthy, and that an operation for appendicitis has been recommended where the patient has declined to be operated upon, and subsequently made a perfect recovery without any operation whatever having been performed.

An excellent example of an illegitimate and indefensible operation is the following:-A blacksmith, aged about 35 years, was suffering from a cancer affecting the parietes of the abdomen just over the region of the liver. Con-. sidering the size and position of the growth my emphatic opinion was that the case was an irremediable one, and that under no circumstances whatever should any operative procedure be adopted. A few days after having expressed the above opinion, a note was sent to me by a well-known operating surgeon, saying that he had been consulted by the afore-mentioned blacksmith and that he had decided to remove the growth, also asking me to be present at the operation, which was fixed a few days later at the patient's own home. Prior to the operation being commenced it was my unpleasant duty to protest against it being undertaken on the grounds that it was absoluely useless, as the growth could not

possibly be entirely removed, that most likely some of the internal organs would be found to be secondarily affected, and finally that the operation would imperil and shorten the man's life. Notwithstanding my protest the operation was proceeded with. It oc cupied close upon two hours, and was only very partially successful. It was found impossible to bring the margins

of the resulting wound together.

Strange to say, the patient did not die under the operation but lingered on in a state of great suffering for about three weeks. He was a member of the choir of a neighboring church, at which a subscription was raised to pay his doctor's bill, which was not a small one, but his wife and children were left in very penurious circumstances. No better example to my mind of a useless and improper operation could be given. To remove any possible misapprehension is advisable to state that the operator in that case has been dead for several years. To sum up, no operation should be undertaken unless there is a reasonable prospect of relief; unless the patient at the conclusion of the operation is likely to be left at least in as good a position as he was before. At the commencement of an operation the surgeon should remember that the thing cannot be undone, that for good or ill the operation is about to be performed, and he should, as far as is humanly possible, resolve that under no preventible circumstances shall his patient be in a worse position as a result of the operation than he was before.

3. Operations that are on the borderland between defensible and indefensible. In many cases a patient may be suffering from such intense pain and misery as to make life insupportable and unendurable; in others the case may be very obscure; again, a case that is certainly fatal unless

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