77PROFESSIONAL ETIQUETTE.-THE CERTIFICATE SYSTEM.

practitioner." Let us proclaim anatomy, and physiologicaland chemical science, and clinical observation, as constitut-

ing our peculiar claims to public confidence. Is it too much

to ask of the Legislature that no one be allowed to practisemedicine, unless he have studied anatomy, physiology, and

pathology; the structure and functions of the machine, thedisorders of which he would r epair ? -? Is it too much to

hope that the public will eventually learn that such know-ledge is required for such an office ?

PROFESSIONAL ETIQUETTE." Metuone quam fraudem fransus sit."

BMR. EDITOR,—May I claim your notice in the present in-stance. Mine is not a private quarrel; it embraces thed,ignity of the profession, the advantage of the public, thesafety of patients, and the convenience of practitioners atlarge. If it were a mere question of obtrusion on a pri-vate patient I should not trouble you with my plaint, but thedoctrine enunciated by the party implicated involves therespectability of the entire profession, and the mutual cour-tesy and gentlemanly bearing which should exist betweenphysicians and surgeons.The circumstances are these :-For some short time I had

Ibeen in attendance on a young lady on whom the treatment Iof a chemist had been previously inflicted. Her case was

progressing a,s favourably as could be expected; but one ofher friends (not a member of the family) was desirous thatsome physician should see my patient: I, of course, assented,stating, that if they selected a gentleman I should communi-cate with him. On my next visit, the mother of the younglady was indisposed to have any second advice; however, Iurged the propriety of gratifying her officious friend. Themother then desired that I should write to Dr. Clendinning.It appears that previous to this arrangement, our anxiousfriend sent a message to Dr. Blundell, of Great George-street,Westminster, at eleven o’clock A. M.; but as the doctor didnot answer the summons up to six P. M., it was conjecturedthat he objected to come, not receiving intimatioii in theusual course. When Dr. Blundell’s name was mentioned, Iproposed sending a note to him, instead of Dr. Clendinning,but to my surprise it was announced, at half-past nine o’clockat night, that the doctor had arrived in compliance with themorning’s request. I repaired to the patient’s house to ascer-tain the fact, and on my entering the room I saw the doctor,with watch in hand, and busy eye intent, his patient grasped,and all absorbed in thought. I startled his consciousness

by presuming that I met Dr. Blundell. He assented, andgreeted my presence with a sinister smile. I asked if he hadknown that I was in previous attendance. He answered,"we don’t enter into the discussion of that subject." I then,in his hearing, inquired of the lady, who stood by him, if shecould satisiy my former interrogatory. She stated that thedoctor was made acquainted with mv attendance. This thedoctor did not then deny. I immediately retired from thesick chamber to an adjoining parlour. In some short time lwas joined by the doctor, who, in answer to my demand foran explanation of how he came to be there, said, with expandedchest, and body erect,-" Sir, I’ll tell you the rule that guidesphysicians, and shall give you my reasons. I consider thatwhen a physician is sent for he is in duty bound to attend, forthe safety of the public, and the advantage of the patient." I

objected, "What! if the safety of the public and the advantageof the patient was previously consulted by having a medicalman in attendance " He answered, " It makes no difference,you medical men might amongst ourselves

" I inter-rupted, and required an explanation of the word, " yourselves,"stating that my understanding was too obtuse to recogniseits meaning. The doctor failed to enlighten me, but con-tinued, " Physicians are bound to protect themselves againstyou medical men; that the latter might, in their medicalsocieties, say they did not like this or that one, and refuse tocall him in; and that physicians should protect themselvesagainst such injustice, and obey every call, in their owndefence, though he acknowledged the danger to be only apossible contingency." I told him I resigned the patient intohis hands; that I would not (at his solicitation) enter into theyoung lady’s case with him; that he might send his prescrip-tion to a chemist, for I would not compound it. I also askedhim if he would act so with a Fellow of the College of Phy-sicians. He evaded an answer. I pressed him. He then

said, in such a case he would hesitate. I then departed, andleft him to reflect on the conduct of a surgeon who dared touphold his dignity.

Now I will not say, are such practices respectable; but Iask, in sadness, are such practices current 1 Do they tend toraise medical men in the estimation of the public, or do theynot facilitate the degradation of the profession ? Is it for theadvantage of patients to disturb their confidence by theobtrusive and furtive visits of a stranger in the dead of night! aOr is it honourable to the profession of physic to be merelyactuated by the lucrun2 accessell8, forgetful of what is due tothe professor of medicine, or even self-respect.On the principle " the doctor" propounds, five or six phy-

sicians might all arrive on the same errand, and some mightfeel it awkward to retire without a fee; but Dr. Blundellpocketed his _feliciter° illi cedat.-Yotirs much obliged,

MICHAEL K. O’SHEA, M.R.C.S.E.

THE CERTIFICATE SYSTEM—ATTENDANCE OFSTUDENTS AT THE GLASGOW INFIRMARY.

To the Editor of THE LANCET.

SIR,-Knowing your sincere desire for the reformation ofevery evil connected with the medical profession, I have takenthe liberty of pointing out to you what I imagine to be anerroneous system of procedure regarding the certificates ofattendance upon the Glasgow Infirmary.

After paying the house fee to that institution, the student,before he can obtain a certificate of having attended the hos-pital for the required period of two years, must inscribe hisname in what is called the " Infirmary Album," which is openfor signature during the last week of every second month inthe year, beginning with the month of February, and ending inthat of December, thus making an amount of only six times inthe year. Now this, in my humble opinion, is no accurate testof the student’s regular attendance upon the hospital duringthe time above stated; because, by making himself thoroughlyacquainted with this regulation, and appearing with the ut-most punctuality at the specified periods, a student may obtaina certificate of having attended the Infirmary for the space oftwo years, although he may have only appeared at the propertime, signed the " Album," and left the house, to reappearagain in two months afterwards. I have known this to happenvery frequently; and while the most irregular attenders gene-rally receive the best certificates, it sometimes happens, on theother hand, that a student, after having attended the hospitalregularly for nearly the whole of the required period, and whohas perhaps omitted to sign the Album once, (either throughignorance of the time for signature, or from having been calledaway suddenly by private affairs,) is, on this account, mostperemptorily denied his certificate of attendance. These re-marks have suggested themselves to me solely on account ofhaving, within the past week, witnessed a most glaring in-stance of the latter description ; and I trust, that in order toopen the eyes of the profession more fully to this evil system,the editor of THE LANCET will pardon this encroachment uponhis columns, and give insertion to these imperfect observa-tions.

A PUPIL OF THE GLASGOW RoYAL IxriRMABY.Glasgow, July, lStõ.

FATAL HÆMORRHAGE FROM LANCING THEGUM IN AN INFANT.

To the Editor of Tiaiz LANCET.

SiR,—In continuation of the case of "Fatal Haemorrhagefrom a Free Incision of the Gum," related in your number forJuly 4th, I should feel obliged by the insertion of the followingfacts:-On the Tuesday following the death of that child on theSunday, it was intended to bury it; but the people of thevillage-the public-demanded that an inquest should beheld. In consequence of this outcry, the constable was sentto Mr. Hall, Coroner, at Uppingham, who, when he hadheard the particulars of the case, said there was no need foran inquest. The day after this opinion was delivered, Ir.Jones, by his own request, met three other medical men(viz., Dr. Hopkinson, Mr. Atley, of Stanford, and Mr. Leet,of Thrapstone) at Cottesmore. They went all together intothe room where the child lay dead ; two of the four passedeach the tip of his little finger into the child’s mouth, andthen endeavoured to explain away to the parents a cause ofdeath to them (the parents) so evident. A statement wasthen made to the clergyman by the four, that it was their