Dr. QUAIN stated that all the composition fees had been invested, save a few recently; but £100, derived from annual subscriptions, had been invested as an equivalent. Mr. ERICHSEN and Mr. CURLING spoke in favour of a sliding scale, and some discussion ensued as to the fairness of raising the composition fee in the case of old members, the speakers insisting that the demand for fifteen guineas as a composition fee should be made only from members elected in the future.

[JAN. 9, 1869. 49

Dr. GREENHOW then proposed that every member elected after January 1st, 1869, may pay a composition fee of fifteen guineas. This was carried.

It was understood that the matter of the sliding scale in the case of composition fees should be considered by the Council.

The ordinary business of the Society then commenced. Dr. MURCHISON read reports by the Committee on Morbid Growths, on Mr. Heath's case of tumour of the tongue, on Dr. Kelly's case of cancer of the femur, which was declared to be fibro-plastic, and on Mr. Adams's case of syphilitic tumours of the leg.

Dr. PEACOCK exhibited a Malformed Heart, removed from a child aged thirteen, and presenting occlusion of the orifice of the pulmonary artery by adhesion of the valves. The aorta arose from both ventricles; the foramen ovale was closed. The question as to how blood got into the pulmonary artery was undetermined, for the simple reason that no special examination had been made touching this point by the gentleman who sent the heart to Dr. Peacock. The latter commented on the importance in cyanotic cases of determining, not only the condition of the heart, but the mode in which the circulation was carried on through the vessels in connexion with it.

Dr. PAYNE exhibited specimens of Multiple Vascular Tumours of the Liver, Ovary, and other organs. The tumours were composed of dilatations of venous channels containing coagulated blood. In the case of the liver the tumours were in connexion with the portal vein; those related to the kidney were injected through a branch of the renal artery. There were also tumours about the ovary. Dr. Payne did not find any similar case in which the tumours were so large or so numerous. The patient died of hæmorrhage from the intestine.

Dr. BASTIAN showed specimens of Embolism in Minute Arteries of the Pia Mater (which he thought might be connected with the production of delirium) taken from a patient who died as a consequence of an attack of erysipelatous inflammation of the head. In the small arteries and capillaries were a large number of white corpuscles aggregated into masses, the larger being about in. in diameter, and plugging up the calibre of the vessels. Some of the masses were becoming granular and fatty. Embolic masses existed in the liver and the kidney. Dr. Bastian had examined cases of pneumonia, rheumatic fever, and other fevers in which delirium occurred, and found similar

masses.

Mr. BARWELL thought that the delirium and the massing together of the corpuscles were the result of the inflammation, and not the delirium the result of the formation of the aggregated masses.

share of the difficulty of returning thanks, he was therefore obliged to speak for all; yet he had to acknowledge himself indebted to those gentlemen to whom the Society had expressed themselves indebted. If, after having the honour and happiness of filling the presidential chair, he, so unaccustomed to such an office, had managed to escape any misadventure, he must owe it to the indulgence of the members and, only less than that, to the valuable co-operation and assistance of those to whom the vote of thanks was offered. Speaking on behalf of the Council, he could not Council had had the misfortune to lose, by death, one of the youngest but not least respected of its members-Dr. Hillier. Pathology was not the chief field of Dr. Hillier's industry, but in more than one field of professional work he was a very efficient and distinguished labourer. Loyally and lovingly attached to his profession, more from the opportunity which it afforded of doing good than from the gains it permitted, he was evidently actuated by a high sense of honour and duty. His untimely death happened under circumstances peculiarly sad. It cut short a career which probably would have led him to eminent personal success, and certainly to a position of more and more public utility. All well-wishers of the profession must have learnt with sincere pain that a life recently so full of the best of promise had terminated before its noonday. What else he had to say would be congratulatory. The prospects of the Society were never brighter; its usefulness never greater. The volume just issued contained abundant matter of the greatest interest to science, and for some time past there had been an increasing interest in the meetings. It would be difficult to pitch upon a subject more pregnant with interest than the one brought forward during that evening in reference to the relation between embolism and delirium. The Society had been greatly benefited by the work of the Committee on Morbid Growths, and the members must have noticed how the Society was tending to advance from the position of mere exhibition to a Society in the largest sense of the word pathological. He could not help referring to the list of men elected as honorary members-a list which, whilst it did honour to the components, also reflected honour on the Society. Amongst the elected might be noticed, not only those whose transcendent researches had contributed largely to pathology (e.g. Virchow), but the representatives of the modern march of physiology in the relation which it bears to pathology. Lastly, he congratulated the Society on the result of the ballot for the officers for the next year-eminently satisfactory as regards the gentleman selected as President. He was known to all as one of the most successful, and to many as one of the kindest-hearted men in existence. But the younger men might not remember, so freshly as the older ones, how he, twenty years ago, contributed to pathology work which marks an era in the matter to which it relates. In conclusion, he thanked them warmly for the vote of thanks just passed, and for the great honour they had conferred upon him personally in maintaining him in that chair for two successive years.

Reviews and Notices of Books.

Dr. BASTIAN said there was no trace of inflammation in the vessels; but that secondary changes around the masses were taking place as in the liver.

The result of the ballot was then announced. In the first place MM. Claude Bernard, Louis, Billroth, Virchow, Ludwig, Helmholtz, and Bruecke were elected honorary members. The list of officers elected for the ensuing year was published by us last week.

Dr. Down moved a vote of thanks to the retiring officers. And Dr. PEACOCK, in seconding the motion, spoke pointedly of the valuable labours of the medical secretary, Dr. Murchison, who had edited the last four volumes of the Society's "Transactions."

Mr. SIMON (the President), in replying, said that as the vote of thanks just proposed to all the officers of the Society had not been subdivided so as to allow each to take his

and their Complications. By JOHN K. BARTON, M.D. Dub., F.R.C.S.I., Surgeon to the Adelaide Hospital, Lecturer on Surgery at the Ledwich School of Medicine, &c. &c. pp. 316. Dublin: Fannin and Co. 1868.

Syphilis and Local Contagious Disorders. By BERKELEY HILL, M.B. Lond., F.R.C.S., Assistant-Surgeon to University College Hospital, Teacher of the Use of Surgical Apparatus in University College, Surgeon to Out-patients at the Lock Hospital. pp. 505. London: James Walton. 1868.

(CONCLUDING NOTICE.)

It is in the eye, perhaps, of all organs, that we have the phenomena and effects of syphilitic action most clearly epitomised, as it were, for our observation,-into its structure and composition there enter so many and such different textures, from the more simple and coarse to those of the

utmost delicacy. The effects of syphilis on the eye might form an interesting subject for a small treatise. In the peculiar forms of corneitis, the earlier and later forms of iritis, the occasional effects of syphilitic diseases of the retina, the lesions of the nerves entering the orbit, and the affections of muscle and bone, we may trace and study the pattern of all the pathological changes induced by syphilis. Surgeons and physicians have often appealed to the iris as illustrating the effects of mercury: how easily and beautifully can be traced the gradual and progressive clearing away of lymph, and the restoration of the iris and pupil to their normal appearance. It is an interesting fact, noticed by Mr. Berkeley Hill, and one which we have ourselves more than once witnessed, that while lymph was being dissipated by absorption from one eye under the use of mercury, an iritis has manifested itself in the other; which clearly indicates that the influence of the mineral is exerted over the products, and not over the other phenomena, of inflammation. Having briefly sketched the progressive changes which have taken place in opinions regarding the pathology of syphilis, we must, still more briefly, we fear, consider the remaining points. While Dr. Barton proceeds to treat his subject according to the different stages observed in the natural evolution of the phenomena, and makes the third stage of syphilis to consist of a period of deposit, with the later symptoms and the degenerations which this deposit may undergo in itself and induce in the surrounding tissues in which it is embedded, Mr. Berkeley Hill pursues a somewhat different course. After giving an outline of syphilis, its causes, mode of propagation, symptoms, and progress, he considers the manifestations in groups, according to an anatomical arrangement,-the skin, alimentary canal, air-passages, bones, vessels, &c., brain and nervous system, and so on.

Up to what may be termed the end of the secondary stage, the evolution of the morbid manifestations is curiously regular; but beyond it, in what is called the tertiary form, there is much more irregularity, and several broad points of distinction exist between it and the previous stages. Whether the tertiary phenomena ought rather to be regarded in the light of sequelae or not has not yet been exactly determined. Probably no syphilitic patient escapes the secondary manifestations, however much these may differ in extent and severity in different cases; but many certainly do not pass beyond them. Not only does it happen that syphilis does not commonly repeat itself in the same body, but the so-called relapses of the secondary symptoms are not in reality true relapses. The pattern and type of the manifestations alter somewhat in their character in the progressive evolution of the syphilitic action. The general manifestations commonly begin about five or six weeks after induration of the chancre and glands, in the form of an exanthem of very superficial character on the trunk of the body. This is preceded by some glandular enlargement, and a certain amount of chloro-anæmia; and the exanthem is often ushered in by slight fever, as we have ourselves ascertained by the use of the thermometer.

According to our experience, there are two distinct forms of syphilitic rupia, one of which occurs comparatively early, while the other is among the latest manifestations, two or three years after infection; the first is attended by a superficial form of ulceration, and the latter by a deeper and more extensive degree of ulceration and larger cicatrices. Zeissl says rupia never appears in inherited syphilis. There is scarcely any internal organ of the body which may not be affected by syphilis. The late Dr. Todd clearly recognised its influence in causing many nervous diseases, and the clinical experience of subsequent observers has cor roborated as well as extended his views. We must touch

upon syphilitic disease of the kidneys and lungs. The former gives rise to what has, not inappropriately, been. termed "syphilitic albuminuria," the latter, to a form of chronic pneumonia, or some localised morbid process which in its symptoms may simulate consumption (syphilitic phthisis). The kidneys are less frequently affected than the liver. The two forms most commonly met with are the diffuse or interstitial, and the circumscribed; and larda. ceous degeneration likewise often has a syphilitie taint for its exponent. In the lungs, we may have a fibrous inflammation or gummatous tumours developed, and the diagnosis will mainly turn upon our ascertaining a syphilitic history. The pathology and morbid anatomy of these cases has been minutely studied by Virchow, Wilks, Pleischl, Klob, and Lancereaux. Mr. Paget, who has, in the course of his professional life, tapped so many springs by his sagacious and/ extensive observation, has added something to our information on syphilitic disease of the intestine. For our knowledge of inherited syphilis we are, as is well known, mainly indebted to Mr. Hutchinson, who has worked at this, and indeed the whole subject, with his characteristic zeal.

With regard to treatment we do not find that recent authors have added anything to our information. Syphilisation has not stood its ground, and the theory of its action is disputed. In common with most men of impartial mind and common sense, the authors under review recognise in mercury the most reliable therapeutical agent we possess. But it must be borne in mind that neither in mercury nor in any other drug have we really an absolutely curative agent. By no amount of mercury or iodine can we exorcise the virus; we can only remove its manifestations. In the degenerative stages, the suppurative forms, and the ulcera-✓ tions with involvement of bone, the effect of iodide of potassium in large doses, and the most careful attention to all: matters of hygiene, demand a fair trial before we have recourse to mercury.

But we must stop. We have gone over a large number of subjects, necessarily in a discursive and superficial way,. only touching most of them, but endeavouring to penetrate beneath the surface of some. In apportioning to the authors of these works the credit which is their due, we have said that they do not enlarge our knowledge by any new obser vations or original expositions. Mr. Berkeley Hill is evidently very familiar with the results of modern continental observation and speculation, and he uses these results with care and judgment. He has expounded his subjects by the light of the latest discoveries and of modern thought, and these may fairly be said to have increased our knowledge of syphilis, and imparted to it that unity and harmony which it previously lacked. As honorary secretary of the Association for extending the Contagious Diseases Act, Mr. Berkeley Hill had the opportunity of gaining much information of a statistical and sanitary character, which he has likewise utilised in his book.

A System of Physical Education. By ARCHIBALD MACLAREN. pp. 516. Oxford, 1869..

FEW men have done more for physical education than the writer of this book. By his gymnasium at Oxford he has promoted in an extraordinary degree the health and vigour of the young men of the better classes, while by his excellent athletic code for the army, and by his influence with successive War Ministers, he has aided largely in intro-/ ducing that admirable athletic training which is transforming the stiff, slow-moving grenadier of old times into the vigorous, rapid, and enduring soldier of modern days. But these services, great as they are, are the least of his merits; he has written on his subject largely, and has written so well and so sensibly, without exaggeration and

WE are not sanguine enough to expect to do away altogether with unqualified practice. With much of this-as, for example, that of chemists-we can only bear. They are not all so ambitious as the Manchester druggist upon whose grievances we commented last week; who acted as the assistant of a surgeon to ironworks; who treated more serious cases than flesh wounds; and whose professional mind was evidently dissatisfied at being paid for evidence in a court of law as an ordinary witness, and not as an expert. Short of this ambitiousness, however, the medical practice done by the lower order of Manchester druggists is highly unsatisfactory, and seems a thing that should be taken into deep consideration by the registrars of the neighbourhood of Manchester and Salford, who have a great deal to do in the way of registering deaths. According to our information, these druggists prescribe extensively. Amongst the poor and middle classes of Manchester they are styled "doctors;" their usual charge is fourpence for each attendance; in "serious" cases some of them visit the unfortunate patients at their homes. This is a great evil in large towns, and one which cannot be dissociated from the high mortality of such towns. But it is an evil for which medical men are not responsible; they cannot control it; and there is this to be said for it, that it serves, by the force of contrast, to benefit legitimate and scientific prac

tice.

We design more particularly at present to comment upon a form of unqualified practice for which medical men are responsible, and which threatens to assume proportions that will defeat the ends of the Medical Act, and injure the legally qualified practitioners of the country. We refer to the employment of unqualified assistants by medical men. Let us say at the very outset that we do not mean to be hard upon a class which has come into existence almost from the nature of things, and which, in lonely and rural parts of the country, includes many men who are really very useful. Thus much is often said to us by practitioners in letters, and the fact is one which partly caused our recommendation last week, that all medical students should, as a part of their education, for a certain time take a share in the duties of a common practice. There is a second admission to be made, that unqualified assistants have been useful in another sense. They have naturally been cheaper than qualified men. Medical practitioners to clubs and in country places are so often imperfectly remunerated that they are obliged to employ unqualified assistants because they can be had for less money than qualified ones. This, however, in itself, is an evil against which we ought to contend, in order to elevate the practitioner, rather than to

lower the assistant.

Having made these various admissions in favour of unqualified assistants, we proceed, with the less hesi

tation, to point out the impropriety of introducing them unduly into medical practice. In doing so we are discussing no fanciful state of things, but a real one that is fraught with most objectionable results. In the colliery districts of Durham, and also at Birmingham, we are informed that it is common for a practitioner, responsible for the medical management of several collieries, to place at various distances from the principal's house unqualified assistants, who, with his plate on their door, practise with all the authority and impunity of registered men. This is a virtual contravention of the Medical Act; and in some recent cases has been punished as such by a fine. It will be in the memory of our readers that one THOMAS HOLLAND was lately fined £20 and costs for practising illegally as a surgeon, though Mr. W. C. DEMPSEY— who has distinguished himself at Oldbury by agreeing to attend sick clubs for a less sum than by the profession at large was thought reasonable-tried to shelter him by saying that he was his assistant. In the same neighbourhood another practitioner tried to protect another person in the same way; but not effectually, and the unqualified assistant was fined £5 and costs. It is of the excess to which the use of unqualified assistants is carried that we complain. The last practitioner to whom we have referred was found on inquiry to have no less than seven unqualified men under the shelter of his name. Surely it was never intended by the licensing bodies that one diploma was to license eight men to practise the holder of it and seven others.

men.

Besides being in distinct opposition to the Medical Act, this employment of unqualified practitioners is open to two other grave objections. First, it is most unjust to qualified The seven unqualified assistants must have done the work of several qualified practitioners. It is unreasonable to think that regular medical practice is to be spoiled by the importation of numerous unqualified assistants under the protection of a qualified principal. We impress upon principals the injustice of such a use of unqualified assistants. But it is not only the regular practitioners, who have been obliged to pass through a long and costly ordeal to acquire the right of practice, that are injured by this extensive use of unqualified men, but it is clearly bad for the public and detrimental to that elevation of the medical art in which the public have so direct an interest. We have admitted the readiness of unqualified assistants; but they are nevertheless uneducated, and cannot be expected to practise medicine in a scientific spirit.

For these various reasons we conclude that while unqualified assistants cannot be altogether dispensed with, yet that it is most objectionable to place them in independent positions in which they virtually replace fully educated medical men. So long as they live under the same roof with a qualified man, and under his strict supervision, we cannot see much cause of complaint; but when this is exceeded— when the unqualified man is placed in charge of what is virtually a branch practice, then, in our opinion, the law is virtually evaded or broken, and properly qualified men are injured, and have a ground of complaint against the practitioner for abetting unqualified practice.