enter the chest does not enter, leaving the lungs in an anæmic condition oftentimes unable to cope with the germs which enter with the dust laden air. The air passing into the lungs is cold, unfiltered and unmoistened, chilling the lung, affecting its lining membrane and circulation. The deposit of dust which might contain noxious germs in great numbers and too numerous to be taken care of by reduced circulation, frequently results in inflammation and tuberculosis of the lungs.

MUCO-COLITIS.

L. Veale, in a paper in the British Medical Journal, on the treatment of muco-colitis, regarded the condition as a secretion neurosis, and attributed the general symptoms to auto-intoxication following the putrefaction of food particles entangled in the retained membranes. The presence of the membranes also led to spasm and distention of the intestines, so that a vicious circle was set up.

In the treatment as carried out at Harrogate the bowel was irrigated three times a week with about 30 ounces of the alkaline sulphur water, which was run in very slowly through a Plombières tube at a temperature of from 96° to 102° F. from a height of 2 feet. The patient lies first on her right side, then on her back, and then on the left side, remaining in each position for two minutes. The fluid was retained for ten minutes, and after it had been ejected the process was repeated. The attendant examined and reported on the washings. The irrigation was followed by a warm sulphur bath with a submassive douche to the abdomen. If constipation was present a small dose of blue pill was given at night, and the hot sulphur water in the morning. The result of this treatment was great improvement in the local and general symptoms. Sometimes more than one course (of

about three weeks' duration) was necessary, or the patient could be taught to irrigate the bowel herself, using artificial sulphur waters; while massage could to a certain extent replace the submassive douche. The diet prescribed was one that left no irritating residue. Fat, pastry, and all green vegetables (except spinach) were prohibited. The patients should take moderate exercise. Drugs were avoided as much as possible, though sometimes a tonic or the iron waters were given. All pelvic disorders received their appropriate treatment. Savill used very large intestinal douches in the treatment of muco-colitis, beginning with one and increasing to five or six pints. The sense of exhaustion that followed was removed by the subsequent application of the high-frequency current. With regard to diet, the speaker recommended cutting off all meat proteids, and giving farinaceous food and milk for a week or ten days, then cream cheese and milk only for a few days, after which a return should be made to the farinaceous diet. Some patients did. well on lactic-acid milk. The importance of treating constipation was emphasized. Pituitary extract had been found useful in some atonic cases.

HYDROGEN PEROXIDE IN PURULENT CYSTITIS.

A. Weith in Semaine Médicale, describes a troublesome case of purulent cystitis in a man of 84 years. Boric acid injections, and afterwards silver nitrate, had no effect. The bladder was then washed with 200 grammes of dilute hydrogen peroxide (2 volumes), with immediate good result. A slight sensation of heat was produced, without any pain, and the amelioration was so marked that nothing more was done for several days. Then the injections were renewed with 3 volume solution at intervals of increasing length, until finally the urine. became clear and the patient was eventually cured.

MEDICINE IN THE ENCYCLOPEDIA BRITANNICA.

The Lancet makes an interesting review of the biographical mention given to medicine in the new edition of the Encyclopedia Britannica.

The article on Galen is unsigned, and is by no means complete, but the details of his life and work are, it is said, to be found in the section dealing with the history of medicine, which has not yet appeared. Possibly this accounts for the omission of any mention of the commentary of Haly ben Rhodoan, by which Galen was known in the Middle Ages through the medium of a Latin translation from the Arabic. Of Celsus there is no mention, neither does the name of Gilbertus Anglicus appear. But it may be expected that the names of both these physicians, together with that of Gaddesden, the first English court physician, will be dealt with in the section containing the history of medicine. The account of Hippocrates has been already alluded to in our article on the section of Anatomy, published in The Lancet of Feb. 25th.

Three of the greatest names in the history of British medicine are those of William Harvey and the two Hunters, William and his brother John, for to their discoveries in physiology, anatomy, and pathology respectively it may almost be said that the first real advances in medical science since the days of Galen were due. The articles dealing with these three great men are models of scientific biographies, clear, complete, and eminently readable. That on Harvey is contributed by Dr. P. H. PyeSmith, who gives an excellent account of Harvey's career and of his great work on the circulation. Harvey's views on the movements of the heart and blood were first put forward in a series of lec

tures delivered as Lumleian lecturer in 1616, but the publication of the "Exercitatio did not take place until 1628. His own colleagues were convinced of the truth of his theory, but in foreign countries, as might be expected, the novelty met with disbelief and occasionally with active opposition, although the opposition as a rule was of a feeble and pretentious nature. Great minds, however, accepted Harvey's discovery, and among these the most eminent was Descartes. Dr. Pye-Smith gives due credit to Servetus for his views upon the pulmonary circulation. Harvey's only other important work, that on generation, was published in 1651. Little is known of Harvey as a practicing physician, but Dr. Pye-Smith quotes an amusing passage from Aubrey to show that his prescriptions were not held in much esteem by contemporary apothecaries. Apothecaries in those days used to collect physicians' prescriptions and sell or use them to their own profit. "But," says Aubrey, "I knew several practitioners that would not have given threepence for one of his bills"; and, "a man could hardly tell by his bill what he did aim at." It is to be hoped that this was due, not to any inadequacy in the prescriptions, but to their being of a simpler nature than was the usual custom of the time. The appended bibliography of Harvey's own writings and of literature concerning him, though naturally the latter section does not pretend to be complete, is of great value, but we think that among the Harveian orations which Dr. Pye-Smith mentions the admirable one by the late Dr. J. F. Payne, entitled "Galen and Harvey," should have been included.

The biographies of John Hunter and of his elder brother William form a valuable chronicle of the lives of these two illustrious workers. William Hunter,

owing to the overshadowing fame of his brother, is, perhaps, not remembered so vividly as he should be, for his work in anatomy, and especially that upon the anatomy of the gravid uterus, was of the greatest value. The memory of John, on the other hand, is kept green before the eyes of all men by the museum called after his name and by the yearly oration, an admirable example of which, delivered by Mr. Edmund Owen, was published in our issue of Feb. 18th last. The biography now before us, from the pen of Mr. F. H. Butler, gives an admirable account of the life and works of Hunter, of his industry, his method. of testing hypotheses by experiment, his many-sidedness, and his great discovery of tying a main artery in its continuity. Of his passion for work an amusing hint is given in one of his letters to Jenner, who had written to Hunter bewailing a disappointment in love; Hunter replied, "Let her go, never mind her. I shall employ you with hedgehogs." He was at the time making researches into the phenomena of hibernation, and evidently considered that if anything could mend a broken heart the study of the hibernating hedgehog would be the best prescription.

Sir William Thiselton Dyer gives an excellent sketch of Huxley, although it deals mainly with the pugnacious and controversial side of his character. No one unacquainted with Huxley's private life would gather from this article what a tender humorous side there was to the character of a man only known in public as one who never spared an opponent when the opponent was in the wrong. But as a picture of the biologist and the expert upon education the article is as clear cut as Huxley's own writings.

THE DOCTOR'S TOP HAT.

Not so very long since, says the London Hospital Journal, even in rural districts, the medical man was easily recognizable to the stranger by his profes

sional top hat and frock coat. Scarcely fifteen years ago the doctor was almost as unmistakable as the clergyman. There were few then who dared to break away from the conventional costume decreed by unwritten professional law, and those who did defy this canon generally suffered for their hardihood. Except perhaps in the height of summer the silk hat was almost obligatory upon the doctor, as much in small country towns as in London and the large cities. But within the past dozen years a complete change has come over the country practitioner's costume; and the main cause of this revolution has been the advent of the motor-car. Except in larger towns the doctor's motor-car has killed the doctor's top-hat; and public and profession alike have accepted this change with equanimity. But there must be many old-fashioned country people who have experienced a real sense of loss in the passing of their doctor's professional uniform. And, indeed, with all its obvious faults, the top hat and its associated coat often seem to lend some additional dignity and impressiveness even to the most dignified and impressive members of our profession. The doctor above all men should pay great attention to his outward appearance-"for the apparel oft betrays the man." It is not humbug or charlatanary which impels him. to look well-dressed and well groomed on all occasions; and this effect was certainly easier to obtain in the old days before the ubiquitous motor-car swept the doctor's top hat into oblivion. To the young and inexperienced man the formal coat was often a definite help in acquiring the elusive "bed-side manner," and in giving the best possible first impression to his patients and their friends. It is not actors alone who feel the adtanage of being "dressed to the part." But the order has changed, and perhaps in a few years the top hat will be a thing of the past even in the heart of Harley Street itself.

THE CREATION OF WOMAN. An Ancient Pension Legend. In the beginning when Twashtri came to the creation of woman, he found that he had exhausted his material in the creation of man, and that no solid elements were left. In this dilemma, after profound meditation, he did as follows:

He took the rotundity of the moon, the curves of creepers, and the clinging of tendrils, and the trembling of grass, and the slenderness of the reed, and the bloom of flowers, and the lightness of leaves, and the tapering of the elephant's trunk, and the glances of deer, and the joyous gaiety of sunbeams, and the sweeping of clouds, and the fickleness of winds, and the timidity of the hare, and the vanity of the peacock, and the softness of the parrot's bosom, and the hardness of adamant, and the cruelty of the tiger, and the hot glow of fire, and the coldness of snow, and the chattering of jays and the cooing of the dove, and the hypocrisy of the crane, and the fidelity of the drake. Compounding all these together he made woman and gave

her to man.

But after a week man came to him and said:

"Lord, this creature you have given me makes my life miserable. She chatters incessantly and teases me beyond endurance, never leaving me alone. She requires attention every moment, takes up all my time, weeps about nothing, and is always idle. So I have come to give her back again as I cannot live with her." Then Twashtri said "Very well," and took her back.

After another week man came to him saying:

"Lord, I find my life is lonely since I surrendered that creature. I remember how she used to dance and sing to me, and look at me out of the corner of her eye, and play with me and cling to me. Her laughter was music; she was beautiful to look at and soft to touch. Pray give her back to me again." And Twash

tri said "Very well," and returned wo

man to man.

But after only three days had passed, man appeared once more before the creator, to whom he said:

"Lord, I know not how it is, but after all, I have come to the conclusion that she is more trouble than pleasure to me. Therefore I beg that you take her back again."

Twashtri, however, replied: "Out upon you. Be off. Will have no more of this. You must manage how you can." Then quoth man. "But I cannot live with her!"

To which Twashtri replied: "Neither could you live without her." And he turned his back on man, and went on with his work.

Then said man: "Alas, what is to be done? For I cannot live either with or without her!"

REFUSING MEDICAL SERVICE. The Lancet takes occasion to reply editorially to a correspond who asks for express an opinion as to whether a medical practitioner is legally bound to give his professional services when called upon to de so, or whether he may refuse assistance, although a fee is tendered. The answer to the question as he states it is easily given: there is no such legal obligation as that suggested. There are, however, other obligations than those imposed by the law to be considered by the medical man who feels disinclined to attend a particular patient-obligations which will have weight in different degrees according to circumstances. We refer to the social or moral obligation, and to that imposed by humanity and professional honour alike not to allow human life to be sacrificed or grievous human suffering to be prolonged on account of any personal antipathy, or of any personal inconvenience, or of any suspicion or even certainty that the attendance given will not be remunerated. The question of remuneration occurs in

the letter of our correspondent; it does not, however, appear to affect the legal obligation as to which he inquires, and the same may be said with regard to the moral obligation in cases of the nature that we have suggested. A medical man may have a strong reason for not wishing to attend a particular person who is able to remunerate him; he may be summoned to do so and may be reasonably certain that there is no urgent need for his services, and also may know that there is another medical practitioner at hand who will be glad to do all that is required. We conceive this to be an instance of the absence of legal or other obligation. On another occasion the same man may have good reason to believe that he is being summoned to a case where the patient's life would be endangered even by a few minutes' delay spent in the endeavour to obtain aid from someone other than himself. Here, of course, the medical man should go at once, and he always does go.

The moral obligation will depend upon a variety of circumstances, but will not be affected in such a case by the certainty or uncertainty of remuneration. But consideration must be given to the probability that in the event of death occurring after a refusal of medical aid, although it may be clear to those who can appreciate the circumstances that death was not in consequence of such refusal, a coroner's jury will record an adverse opinion upon conduct of which a possibly prejudiced and inaccurate account will be made public. This is a separate element of the case to be taken into account in arriving at a decision; it does not affect the moral obligation. But the position of the medical man in relation to some who desire to be his patients is not that of a person who, because he has devoted time and money to acquiring scientific knowledge and skill, is expected to be the servant, paid or unpaid, of anyone who may desire to employ him. This view our correspond

ent may rightly resent, refusing not only for his own sake, but from a sense of what is due to his profession to be so regarded. On the other hand, the medical practitioner who analyses the incidents of his professional life will remember many occasions on which he has found himself called upon to exercise his scientific knowledge and skill by a sentiment of humanity and a feeling of duty beyond his own control, but influencing equally his fellow men in other walks of life, or in the ranks of unemployment, according to their qualification to assist in attaining the same object. In illustration let us suppose a child to have fallen into water and to have been rescued by a passer-by at some risk of his own life, and to the certain injury of his clothes. The child is laid insensible on bank or towing path at the feet of a medical man also present by change. The latter, of course, without hesitation devotes himself immediately to the resuscitation of the rescued child. No question of remuneration, of parental gratitude, or of any other consideration arises in his mind any more than it did in that of the layman who had the opportunity to save life and took it, being himself perhaps aided by proficiency as a swimmer. Either the primary saviour or the second saviour. of the child may later find their services rewarded, but neither would act with this idea before him. If, however, we suppose the medical man to be at home at the time of the accident, and to be summoned by messenger, when more or less busy with other matters, we shall see that our criticism of him should he refuse to attend will depend not upon the urgency of the child's need of treatment, but upon the extent of the medical man's knowledge of that need, upon the clearness of the information conveyed to him, upon his power to leave the matter in hand (possibly a patient also requiring his attention), upon his knowledge that no other assistance than