and necessary ablutions for cleanliness. If such an observation has been made I have not seen a record of it. In three of the cases after a cessation from the administration of the baths lasting several days on the recurrence of pyrexia subsequently they were immediately resumed, and in one of these cases there followed a very temporary hæmaturia and albuminuria. Its failure to occur in the other two cases and a knowledge of the vagaries associated with the methods of onset of nephritis in scarlet fever cause me to look upon this occurrence as accidental. From the fact, however, that any pyrexia subsequent to the second week connected or not with other local evidences of inflammation (adenitis, tonsillitis, etc.) may, after a variable period, be accompanied by signs of nephritis, I do not think pyrexia occurring after the period mentioned, when following an apyrexial interval, should be so treated. I am further strengthened in this belief by the fact that in these late pyrexial attacks, whatever may be their cause, the degree of temperature attained or the length of time it lasts rarely constitute an important or dangerous factor.

From the references which I have quoted earlier in this paper it will be remembered that various beneficial effects have been described by different writers as the result of the application in the febrile state at the onset of scarlet fever of water at a temperature lower than that of the body. Personally it seemed to me that the most striking feature, and the one showing an immediate evidence of their action, was their sedative influence. In this respect they often acted in a manner remarkably similar to that met with in typhoid fever, the patients falling asleep directly after their completion.

Despite the fact that some writers are averse to cold baths on account of the danger of producing collapse, whilst others from a similar fear prefer them to continued lukewarm baths, it may yet be said that the consensus of opinion expressed is in favour of some form of hydrotherapy. To a certain extent the discrepancies in the statements may be only apparent, arising from different methods. If one considers the contra-indications laid down by Leichtenstern and mentioned by von Jürgensen concerning three of them (laryngeal stridor, hæmorrhage, arthritis) there can be

no difficulty. With the remaining point, however, the condition of the circulation, it is quite different. is quite different. In accordance with the rule for abstention mentioned by Currie, viz., coldness of the extremities, or in the presence of cyanosis with a small, soft, rapid, running pulse, or with a temperature considerably below what ought to be expected from the general condition, one may feel that the indications are sufficiently clear for a general agreement. On the other hand, there must be numbers of cases borderland which have to be left to individual judgment and in which the results of treatment will be followed by differences in experience.

on the

From the evidence of Leichtenstern and Reimer I think we may accept the conclusion that short cold baths frequently repeated give the greatest benefit, so that where there is no danger of producing cardiac failure, they, or such substitutes as the cold pack with friction, the cold mitten or ice rub rapidly performed, are to be adopted. In doubtful cases, however, and in young or weakly patients the lukewarm bath, as I have described, is to be preferred, and here again its duration should be short (10-15 minutes), since, as stated by Reimer a prolonged tepid bath causes a weak pulse and is decidedly injurious. Whatever the method used it is nevertheless necessary that the applications should be regularly and frequently repeated during the period of pyrexia or marked toxæmia and that each application should be adequate to the severity of the case.

1. Medical Reports, 1805.

2. loc. cit. Additional Reports, p. 59.

3. Medical Reports, p. 17.

4. Clin. Med. Art. Scarlatina.

5. Quoted by J. Lewis Smith.

6. Deut. med. Wochenschft., 1882, pp. 617, 618, 632.

7. Allchin, Manual of Medicine.

8. Encyclopedia Medica.

9. Hare's System of Pract. Therapeutics, 1892.

10. Diseases of Children.

11. Nothnagel's Encyclopedia. Art. Scarlatina.

LITERARY CAUSERIE.

IV.

By WILLIAM STIRLING, M.D., D.Sc., LL.D., Professor of Physiology and Histology in the Victoria University of Manchester; Dean of the Medical Faculty.

THE HIPPOCRATIC AND OTHER ACADEMIC ОATHS.

Hippocratic Oath.

THE oldest and most famous oath connected with the profession of medicine is that known as the Hippocratic Oath. It is not certain that Hippocrates himself was its author. Indeed, from the form it takes in part at least it is more like an indenture between a physician and a pupil. Kurt Sprengel has argued that it comes not from Hippocratic or pre-Hippocratic times, but from the School of Alexandria. There is no good evidence in support of this view. It shows that already in very remote times there were regulations binding the pupil and physician to observe certain regulations; the pupil, being duly instructed in his art came under certain obligations to his teacher. The medical guilds of remote times were represented by the Asclepiada, while the oath that bound the members of the craft, guild, faculty or brotherhood is regarded as the oldest Greek medical oath extant, and its provisions practically cover all the various sponsios, vows and oaths that have been formulated in the various schools of medicine.

"I swear by Apollo the Physician, and Esculapius, and Health and All-Heal, and all the Gods and Goddesses, that according to my ability and judgment, I will keep this oath and this stipulation to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required, to look upon his offspring in the same footing as my own brothers, and both teach them this art, if they shall wish to learn it, without fee or stipulation; that by

precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine; but to none others."

"I will follow that system of regimen, which according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion."

"With purity and with holiness I will pass my life and practice my art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves."

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to hold this Oath unviolated, may it be granted to me to enjoy life, and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my

lot."

In Greek and Roman mythology Apollo was regarded as the "Healing God." Hygeia and Panacea were two of the four daughters of Hippocrates. Indeed, Ovid speaks of Apollo not only as a god but the inventor of the art of medicine itself.

'Inventum medicina meum est; opifer que orbem

Dicor, et herbarum subjecta potentia nobis."

Not the least important part of medical ethics is the duty incumbent on all practitioners of medicine to observe a discreet silence regarding the illness of their patients. The bond of secrecy" is one especially observed in France, where it is a culpable offence to betray professional secrets.

66

It may be remembered that when Osbaldistone accidentally

encountered Rashleigh in a secluded spot not far from the High Street of Glasgow, and when Rob Roy forcibly separated the combatants, Osbaldistone finding himself wounded by the rapier of his cousin, "stopped at a small unpretending shop," that of Christopher Neilson, surgeon and apothecary, who after applying some lint and some what else he thought proper to the trifling wound, observed, "There never was button on the foil that made this hurt. Ah! young blood, young blood! But we surgeons are a secret generation. If it werna for hot blood and ill blood, what wad become of the twa learned faculties."

Leaving aside the moral reflection, the pawky humour, and accurate diagnosis, we have the obligation of secrecy declared on the part of the surgeon.

So far as I am aware the medical graduates of the newer Universities are not required to take any academic oath or sign a sponsio, although some form of plighting troth and swearing allegiance was customary in all the older Universities. In Salerno a particularly quaint ceremony accompanied the admission of a graduate, doctor or magister. This I pass over in the meantime. The "Serment" taken before the bust of Hippocrates in the University of Montpellier may be regarded as a fair example of the form of academic oath in one of the oldest Universities of France-for Montpellier, the School of Rabelais, was a great centre of Hippocratic medicine in the twelfth and thirteenth centuries. Indeed, the oath reflects in part the original Hippocratic oath. The quaint ceremonies attending the admission to the degree are described in the Hora Subseciva. Anyone interested in this matter will find a picturesque description of this ceremony given by Dr. John Brown, of Edinburgh, in his famous essay on Locke Locke and Sydenham. In the "Life of Joseph Jordan," the Manchester surgeon, a description is given of the ceremonies at Leyden.

Oath taken by Medical Graduates at the University of Montpellier.

Serment.

En présence des Maîtres de cette École, de mes chers condisciples et devant l'effigie d'Hippocrate, je promets et je jure, au nom de l'Etre suprême, d'être fidèle aux lois de l'honneur et de la probité dans l'exercise de la médicine. Je donnerai mes soins