be stated, because the American writer has forestalled, to a great extent, the authors of the works under review, by having entered on the same field before them. The labours of Dr. Wilks, Hutchinson, Henry Lee, and others in this country, have done much of late years to advance our information in the same direction. And we all know that, since the day when Ricord opened the gate and indicated the road, there have never been wanting surgeons among his countrymen to enter on it successfully; for syphilis is a sort of pet with the French school. When we consider syphilis as a whole, what a marvellous disease it is. It depends upon a virus which readily generates its like; it is specific in its outward manifestations, and definite in its course. Contrasted with the effects of other animal poisons, how tardily the manifestations are evolved. There is the incubationary stage before the appearance of the local lesion; another interval, and the various secondary phenomena, separated from one another by broken periods of rest; and lastly, in some cases, we have a third series, more or less remote, and sometimes separated from the former by many years of average health. During the time that these morbid processes are being manifested in the individual, he is endowed with the power of transmitting a syphilitic taint to his offspring, which shall leave its mark on their tissues years afterwards, modifying the products of their nutritive and developmental functions in a way which transcends our power to explain. On what do these cyclical characters depend? and how can we explain a morbid process marked by periods of activity at one time, and latency and dormancy at another? Virchow has attempted to fathom the cause by supposing that each separate diseased tissue is the source whence the infecting elements are derived, by their gradual absorption and accumulation in the blood. The works under review have very much in common, of course. Taking them in the order in which they reached us, we may begin with Dr. Barton's book, which is less extended than that by Mr. Berkeley Hill, for the latter includes gonorrhoea, its complications and sequelae, which the former does not. Dr. Barton, like Mr. Berkeley Hill, has laid every authority of importance under contribution, and he draws largely upon the comprehensive work of Lancereaux among others. We are very glad to perceive, when specialists are rampant, that he disclaims all title to that term. We heartily agree with him that the subject of syphilis is essentially one with which every practitioner, the physician as well as the surgeon, should be familiar. There was a really good pretext for surgeons making the subject a specialty; but the progress of our knowledge has been retarded rather than advanced by their so doing. How comes it that we have not long ago recognised the truth, which has now been fairly conceded, that the external manifestations of syphilis are not the whole, nor always the most important part, of the morbid phenomena? The physician beholding a patient with disease of one or more internal organs, had to work out for himself its origin in a syphilitic taint acquired years before. We know now that the tendency to the production of a lowly-organised lymph in the connective tissues, induced by the syphilitic taint, is not limited to the external organs, but that the same morbid product takes place in the internal structures, leading to their enlargement, induration, and subsequent contraction or softening; and the knowledge is of more than ordinary importance as regards the patient, because the symptoms would often lead us to imagine that the structural changes were progressive and irreparable, whereas they are ofttimes most amenable to appropriate remedies, when the correct clue to their pathology has been obtained. be in accord as to whether the primary lesion of syphilis We had marked many passages in Dr. Barton's book for It was hardly to be expected that medical observers would manifestation of syphilis-which is from the first a consti THE LANCET,] FOREIGN GLEANINGS.-THE ABYSSINIAN PROMOTIONS. tutional and not a local disease, and cannot be destroyed by caustics,-namely, the elevated desquamating papule, the superficial ulcer, and the indolent ulcer with hard base. These are, he holds, quite independent of any change produced by the admixture of irritating matter with the vehicle of the virus-to wit, that from suppurating chancre or inflamed ulcers, which materially affects them. When irritating matter is inserted with the virus, the changes at the point of inoculation are either those set in action by these latter affections, or a compound of them with those proper to syphilis, the chief of which is induration of the tissue around the inoculated point. He makes a good deal of the effects of local irritation on the initial manifestation in modifying its character and course; pus, whether obtained from a soft chancre or other sources, leading to irritation or inflammatory action. This is not a new idea. Amongst a good many other points connected with syphilis and its pathology, it is one dwelt upon in Dr. Marston's papers in THE LANCET and the Medico-Chirurgical Transactions. There are some matters which are not yet cleared up in either of these works, such as the possibility of physiological absorption of the poison-to wit, its entrance without local manifestation; the physiological effects of tissue (if any) on the character of sores; the exact explanation of those rare cases in which syphilis has been manifested after urethral discharge when no chancre has been detected; the syphilitic lesions of the female, and the relative frequency of induration, and the explanation of its comparative infrequency; the contagious properties, if any, possessed by the uterine discharges of a syphilitic female where no ulcerative action can be discovered; and several other points. And some of these inquiries have the most important practical bearing. We are striving to establish an extended system of legislative interference with the subjects of this disease, with the view of limiting the spread of contagion; but we do not yet know with certainty whether a prostitute labouring under secondary constitutional manifestations may be at large in society with security to public health? We want more original work and observation amongst our English surgeons who write on these subjects, and not to see them going over the old ground, or following the track of continental authorities. Now that Lister's antiseptic method has found so much favour, it would be well to turn to Polli's system. Starting from the current notion of the existence of zymotic diseases, the Italian professor gives large doses of the alkaline sulphites in these complaints. He considers that these salts act by modifying the morbidly fermenting matters, the economy being then able to resist their noxious influence. Dr. Ferrani has published two cases of pyæmia in the Annali of this year wherein he succeeded in arresting the disorder. One was the result of the bite of a dog on the knee; the other, a case of amputation of the thigh. In the first the sulphite of magnesia was given (about two drachms a day) after pyæmia had set in; in the second, before the septic symptoms had occurred: in both successfully. Dr. Ferrani observes that a sufficiency of water should be given with the sulphite of magnesia, as it requires twenty parts of water for its solution, sulphite of soda requiring only four. Acid drinks should be avoided. Let those surgeons who now so steadily follow Lister's plan give the sulphites also; they will then, according to Pasteur's and Polli's theories, attack the enemy on both flanks. DERBYSHIRE NECK. [JAN. 2, 1869. 15 Dr. Lücke, of Berne, has lately published, in the Berliner Kl. Woch (Dec. 28th, 1868), an article in continuation of a former paper inserted in the same journal, touching the method of treating hard goitre by injections of strong tincture of iodine into the parenchyma of the tumour. In small goitres, one puncture at a time, with the syringe of Pravaz half filled with tincture, seems enough; in larger growths, two punctures may be made at the same time. These injections should be renewed at intervals, which the author cannot fix beforehand. If the local and general reaction is not considerable, the operation may be pretty often repeated. The reaction may be very powerful, and it will therefore be proper not to attempt the injections when the patient is in danger of being asphyxiated by the pressure of the tumour. Dr. Lücke mentions cases where reduction of the growth took place very rapidly; and he congratulates himself on his success. When, from its mobility, the tumour cannot easily be punctured by the canula, the author advises the use of a continuous current by means of needles implanted in the parenchyma; but this method has not been very successful in his hands. Large masses of strumous glands might also be treated by injection of tincture of iodine into their interior. OVARIOTOMY IN FRANCE. M. Kæberlé, of Strasbourg, has recently published in a brochure the results of his experience of ovariotomy. Besides the interest which attaches to the subject, and to the views rience of ovariotomy, the pamphlet presents an excellent of a surgeon who, of all Frenchmen, has the largest expestatistical novelty in the shape of tinted diagrams, showing at a glance the results of the various operations. M. Koeberle has now performed ovariotomy sixty-nine times, and exactly One point two-thirds of the cases have been successful. especially deserves notice, which is, that out of the last twenty-two cases four-fifths have been attended by success, or, in other words, five only terminated in death. We thus. have unmistakable evidence of the benefit derived from the skill and improvements which are obtained by experience. It is also of much practical value to note that the mortality has been in direct ratio to the duration of the operation. CATARRHUS VESICE. This disagreeable chronic complaint is often very obstinate; it may therefore just be stated that M. Mallez has found the following solution injected into the bladder very efficacious: water, ten ounces; tincture of iodine, forty-five drops; iodide of potassium, fifteen grains. When the pain is very annoying, add fifteen grains of extract of belladonna to the above. He has also employed carbolic acid, nitrate of silver, and hyposulphite of soda, with advantage. THE ABYSSINIAN PROMOTIONS. Currie, C.B., the talented chief of the medical department SIR,-Will you kindly point out that the promotion of Dr. of the late Abyssinian army, to the rank of Inspector-General, for his valuable services in the field, has entailed upon him a heavy pecuniary loss, as it has necessitated his vacating a valuable inspecting appointment in India, and resulted in his being placed upon half-pay. Such being the case, it is of conferring upon him the honour of K.C.B., to show his' to be hoped the Government will take an early opportunity promotion was really meant as a reward, and not as a punishment, which it has proved. It would, likewise, be a graceful compliment to the department were the same honour conferred on Dr. Logan, C.B., the respected head, under whose genial rule this vexed department has at length become more popular and contented than formerly. I am, Sir, yours faithfully, December, 1868. AN ARMY SURGEON. THE ACTION OF NITROUS OXIDE.-The current number of the Transactions of the Odontological Society inquire into the action of the protoxide of nitrogen, which contains the report in full of the Committee appointed to we recently noticed. The discussion which followed the reading of the report is also given in extenso. THE LANCET LONDON: SATURDAY, JANUARY 2, 1869. efforts can supply; and it would be easy to illustrate our position by reference to the words and works of men of great natural powers, great industry, and consequent great attainments, who, nevertheless, strive in vain to please the fastidious or to satisfy the philosopher. The great drawback to our profession, the great hindrance to its holding its proper place in society and in legislation, is that men of imperfect education have been admitted into our ranks; and the only reform really needed amongst us-the one reform that would comprise all others-is to exclude them rigorously for the future. Once admitted, they become→ because a chain is no stronger than its weakest link,-in one sense, representative men. It is impossible to overlook the change that has taken place in the status of the clergy, as an effect of the admission of "literates" to holy orders; and a similar change, although in the opposite direction, would speedily follow the strict enforcement of a demand for real liberal education amongst ourselves. Even if the training afforded by apprenticeship had been, in all cases, what its advocates assert, we should still hold that it entailed more loss than gain, and that any return to it was impossible. It is not on that account, however, to be supposed that we would exclude the general medical practitioner from all share in the great work of medical education. He might take his part, and that a most important one, at a later period. We would suggest that, when some advance had been made in the student's career, when he had acquired and given evidence of sufficient knowledge to be trusted in positions of some responsibility, it might be made part of his recognised course of study to go and take a share in the active duties of a practice, before being himself admitted to examination as a practitioner. To an advanced student, six months thus spent would be fruitful of good. It would be necessary for the authorities to require evidence of the suitability of the practice to which a young man was sent; and the temporary tutor would, of course, receive a proper payment for the instruction, opportunities, and countenance that he would afford. The pupil would at once be capable of being made highly useful; but the standard of efficiency of a "qualified assistant" would not be expected from him by anybody. OUR attention has recently been called by many correspondents to the defective character of modern medical education with regard to certain matters that are of considerable importance, and that cannot, from their very nature, be included within the scope of hospital teaching as it is at present conducted. It is manifest, we apprehend, that the power of a young medical man to commend himself to the public will be much dependent upon his familiarity with the symptoms and management of a variety of trivial ailments, nursery and other; and upon his power of talking to and managing patients, altogether without reference to his knowledge of their diseases. The old system of apprenticeship, however great its disadvantages, did certainly educate young men to the actual details of their work in life, taught them how to ask customary questions, to express customary sympathy, and to explain common ailments by the customary explanations. It taught them also how to conduct professional business; how often to visit patients, and when to retire from the convalescent; and it afforded them opportunities of treating maladies that are common in practice, and that are seldom or never met with in hospitals. Complaints now reach us to the effect that the young men who obtain licences from the examining boards have probably never seen scarlet fever or measles; that they betray at once, to the perceptions of experienced patients, their ignorance of the various and time-honoured shibboleths of the family doctor; that they are unskilful dispensers; and that, in short, although qualified, they are of little value as assistants. The real pinch of the grievance, moreover, is that the practitioner of a few years ago, who took an apprentice, who taught him the particular matters in question, and who then, without expecting too much, made the best use he could of him, was the gainer of a handsome fee by the transaction; while the practitioner of to-day, who receives no fee, finds that he has to pay a 66 qualified" assistant to do the apprentice's work. The case is one that eminently deserves consideration, and for which it would not, we think, be difficult to find an appropriate remedy. As regards apprenticeship, however, there can be no ques-England-the College of Surgeons and the Apothecaries' tion of its revival in any form. It is the proper entrance to a mechanical trade, and to a mechanical trade alone. As designed by the framers of the Apothecaries' Act, it was absolutely prohibitory of a liberal education; and, even as commonly modified by private arrangements, it was prohibitory in a very great degree. We are now beginning to understand that Medicine presents to its followers the most complicated and the most profoundly difficult problems that attend upon any branch of human inquiry; and that these problems not only cannot be solved, but that their conditions cannot even be appreciated, excepting by faculties that have been prepared for the task by careful educational training in early life. The want of this training no after The only objection we can foresee to this proposal may be summed up in two words-money and time. We reply. that the money and the time would be well spent. It has been the traditional policy of the chief examining boards in Company-to foster the cheap and nasty, and to wink at all sorts of arrangements by which the time supposed to be devoted to study was really given to the earning of daily bread. In this way a few very poor men have been enabled to enter the profession; and it would probably have been better for everybody, and especially for themselves, if they had been kept out. But the examining boards were held to be justified by the plea that was advanced by the lawyer who took a fee in copper from his client. It was all the client had. The College obtained the money for its diploma, and it could not bring itself to insist upon time that the student could not afford to bestow. Save in the most exceptional circumstances, the medical THE LANCET,] THE PROSPECTS OF POOR-LAW REFORM. profession, if it is to be followed with dignity and selfrespect, requires the possession of moderate capital; and there can be no worse policy than for its rulers to aim at cheapness of education. When examiners underbid one another in requirements, their licentiates, quite naturally, underbid one another for parish appointments and for clubs. The poor man, like the illiterate man, is a weak link. He seldom does much good for himself, and he often does incalculable mischief to others. We feel for him as an individual, but we are none the less sure that he must perish in the " struggle for existence," and none the more desirous that the whole profession should be injured by his struggle being unnecessarily prolonged. ALTHOUGH, to some, the present moment may not seem a particularly hopeful one for projects of large and liberal Poor-law reforms, there are certain features in the situation which, on reflection, will perhaps warrant a more reasonable expectation of effective measures than was really justifiable on any previous occasion. No doubt, at the first glance, all seems confusion. All the selfish and unconscientious, and not a few of the truly sensible and humane, among the ratepayers of London have taken fright at the threatened expenses which are to attend the working of Mr. HARDY'S Metropolitan Poor Act. They complain that large expenses, involving a very serious increase of the rates in some districts, are to be saddled upon them; and that the inevitable results will be undue elevation of the condition of the sick and infirm paupers over that of the sick and infirm who are merely poor, and increased temptation to helpless individuals to place themselves, and to families to allow their helpless members to be placed, on the charges of the State. On the other hand, the abuses engendered by the clumsy methods of dealing, not only with such special matters as the treatment of sick persons, helpless women, and destitute children, but with the apparently more simple matter of able-bodied paupers, which are in fashion with local boards, have grown to such an enormous magnitude that pauperism seems to threaten, in London at least, to assume dimensions as alarming as those which at last made the old Poor Law a bye-word and a reproach, and evoked the stringently repressive legislation of 1884. There are moments in which even the calmest and most humane seem to feel the problem to be insoluble, and to wish that it were possible to sink the entire pauper population to the bottom of the sea, and have done with them. We do not wish for a moment to underrate the gravity of those difficulties which beset the question of Poor-law reform. And we are quite ready to admit it was unfortunate, though inevitable, that public attention could in the first place only be aroused to the necessity of one of the many Poor-law reforms which for years have been urgently needed. When, in the year 1865, THE LANCET seized the opportunity afforded by the scandals of GIBSON'S and DALY'S deaths to make the first onslaught on the iniquities of the existing system, there was only the most feeble and vaguelydiffused impression of discontent with the Poor Laws among the mass of the public. A few men, and a good many ladies, knew how detestable the whole system was; but to [JAN. 2, 1869. 17 touch the masses it was necessary not only to heap proof upon proof, but to present the evidence in a form which could not escape attention. Naturally, we preferred to speak first to the public on those matters as to which it could not be denied that we have the right to judgenamely, of the treatment of the sick and infirm under the Poor Law. But this journal, even while urging (and that with triumphant success) the paramount claims of the sick to relief from the gross injustice and cruelty inflicted upon them, has never forgotten that any true legislative reform ought to deal, not merely with sick paupers, but with pauperism generally; and the proof of this is to be found in the fact that we have consistently maintained the necessity of equalising the poor-rates in the metropolis as a preliminary to any measure of relief. We objected, from the first, to Mr. HARDY's scheme, because it did not include a general rearrangement of all funds for poor relief in London upon a common basis. And we still more strenuously protested against Mr. HARDY'S conduct in refusing even to make uniform the impost and the expenditure of taxes for the sick. We prognosticated (and, as the event has proved, with justice) that such half-and-half measures could only result in the union of the well-known vices of local and much subdivided administration, with the unpopularity engendered by prejudices against what would be taken by the ignorant for a measure of "centralisation." The difficulties and the discontent which we foresaw have arisen; but our own part in the successive transactions is apt to be førgotten. Our final judgment of Mr. HARDY'S legislation is the same as our first. We look upon his efforts as a faint and ill-directed scratching at the surface of the work before him; and we should say that, in the progress towards true reform, his measures occupy the same position as the irritation of the Egyptian conscience by the plague of lice may have held to its final arousal by the death of the first-born. The final moral of our remarks is this: that far more extended and detailed information upon all questions of Poor-law relief than has yet been authoritatively put forth is needed; and that it is the duty of all earnest politicians to promote an investigation, by Royal Commission, of the whole subject of pauperism. So plainly is the necessity for this becoming visible, that we have great hopes that the present session may witness something considerably more useful than a mere patching-up of Mr. HARDY's imperfect though well-intentioned scheme-may witness, in fact, a general and honest reconsideration of the fundamental principles of poor relief, and a final condemnation of the senseless and most wasteful system which at present deals with widely differing social questions upon the one principle that they all concern the lowest class of the population, and may therefore be fairly managed by the least-educated per sons in the lowest class but one. An important will case has lately been decided, after a six days' trial in the Probate Court, which teaches certain lessons that it may be sincerely hoped our medical brethren will take to heart. A will was propounded by which a very old gentleman named ANDERSON, ninety-three or ninety-four years of age, was supposed, in the last year of his life, to on the latter occasion exchanged not a single word with him, for, in fact, Mr. ANDERSON could not articulate. Mr. STABB had certainly attended the testator at intervals during the whole six years before the execution of the will. But it was proved, in his examination, that those attendances were for trivial complaints, and that Mr. STABB found the old gentleman so purely passive, so vegetative, if we may use the expression, that he found it necessary to address questions to, and receive answers from, the housekeeper almost exclusively. When asked to attest the will Mr. STABB does not appear to have asked a single question as to the testator's capacity, nor did he hear him utter anything, except a doubtful monosyllable, during the signing of the document. Of course, both the medical men expressed, on examination, the opinion that the testator was of sound mind; but each of them appeared to be in ignorance as to all the more important features of his mental state, as exem have made important alterations in the disposition of his property, by which he deprived his only son of a considerable portion of his estate, which in all previous wills he had left to him, and which he now divided among certain persons not at all related to him. Besides the diminished inheritance thus left to the son, the pain was inflicted on him of seeing himself thrust out of the executorship, which was left in the sole hands of those very persons to whom the will propounded gave a large part of his natural inheritance. It was attempted to be shown that the old man had ample reason for this change in the disposal of his property, having been, in fact, justly offended with his son on the score of his unkind treatment of him. On the latter head, however, the plaintiffs' story completely broke down, and it was shown to be entirely without foundation. And it was proved, by overwhelming evidence, that at the time of the execution of the final will the old man was unmistakably imbecile, and altogether incapable of origin-plified by his habits, &c., and to have been considerably ating any ideas for himself; so that the only possible inference remaining was that the plaintiffs, and a housekeeper of the deceased, who had been constantly about his person, must have themselves dictated the will. The jury showed how decidedly they were of this opinion by intimating that they had made up their minds as to the facts while as yet only a small part of the case for the defence had been heard. The will was set aside. The We are not concerned here with the conduct of the plaintiffs in this case, who benefited under the disputed will; on that the public will easily form its own judgment. But we cannot help noticing the fact that the will of this imbecile old man-about whom it was sworn that for years previous to his death he had never articulated a single connected sentence, and that he never originated any ideas except upon the most trifling matter of gossip; and about whom evidence would have been given, had not the case been stopped, that he had become so completely demented as to have taken to filthy personal habits,-that this imbecile person's will had been witnessed by two medical men. gentlemen in question, Dr. TETLEY and Mr. STABB, of Torquay, are quite beyond suspicion of the remotest evil design; indeed, they occupy a particularly respectable position in the profession, and justly enjoy a very large amount of public confidence. They have, nevertheless, in the present instance, committed a grave ethical fault, from mere want of care. As a general rule, it is very much better in every way that medical men should have nothing to do with the execution of other people's wills, whether as witnesses or in any other capacity. But assuredly every medical man ought at least to be well aware that if he does sign his name as witness to a will, that attestation will be considered as meaning very much more than the attestation of a common witness. Common sense presumes that a medical man would never commit himself to such a step unless he had reason to entertain a very decided opinion as to the testator's mental competency for testamentary acts. sorry to say it is too evident that neither Dr. TETLEY nor Mr. STABB had taken the slightest precaution to obtain this assurance respecting the state of the testator's (Mr. ANDERSON'S) mind. The former gentleman had not seen the testator for six years previous to the execution of the will, and We are startled when these details were revealed subsequently to his decease; and it is obvious that their persistence in the affirmation of his sanity can only be regarded as a defence of their own professional characters. It is a notable circumstance, also, that neither of the doctors appears to have inquired at all as to the nature of the alteration in the will about to be made by a tottering and speechless old man who was entirely surrounded by persons not related to him, his only son being absent, and not having been summoned. In short, the whole conduct of the medical witnesses to the will shows very serious want of care, leading to most unpleasant consequences. We are sure that no medical man who reads our remarks would care to experience the mortification which Dr. TETLEY and Mr. STABB must have felt when the whole circumstances were revealed, which they ought themselves to have ascertained, with respect to the state of the testator's mind, and the neglect of which put them momentarily in a very disagreeable position. THE highly interesting subject of the connexion between the prevalence of consumption and the wetness of soil in different districts, and the influence of climate on the cure of phthisis, was brought under the notice of the Medical Society of London, at its last meeting, by Dr. BUCHANAN. It is only within recent years that the material has existed from which to draw the important conclusions that have been so admirably worked out by Dr. BUCHANAN in this country, and enunciated in great part by Dr. BOWDITCH in America. The great advance in the method of studying the subject in its relations to the practical question of the treatment of phthisis-for that is the point of special and immediate interest to the practitioner- was made, Dr. BUCHANAN acknowledged, by Sir JAMES CLARK among English physicians; who showed that very satisfactory results were obtained by consumptive invalids selecting well-chosen sites of residence, not only abroad, but in England, the value of climatic treatment being of course best marked in the earlier stages of the disease. Dr. ARCHIBALD SMITH and Dr. WEBER have done much to add to our reliable knowledge on the same point. Dr. WEBER also has discussed the whole question of the influence of climate on phthisis in a most |