414 AN EDINBURGH PROFESSOR ON MEDICAL ETHICS.

distinguished in all branches of learning. The distinction

drawn by Professor GREENFIELD is perhaps capable of beingconsidered somewhat invidious, and we have no intention of

endeavouring to appraise the relative merits of universitiesand corporations. There is, however, one point in whichthe corporations undoubtedly show to advantage in com-parison with the universities, and that is in respect of

the question of medical conduct. The corporations some-times administer discipline to their members, even to

the measure of excommunication. If the members

violate the regulations of a corporation in the matter

of professional ethics they are rebuked, and if theydo not repent they are deprived of their diplomas andremoved from the roll of membership. Most of the

universities have no such powers over their graduates,and some of them do not seem to wish to have them.

"Once a graduate always a graduate" is their doctrine.

Graduates are, according to this view, the only class to

whom the punishment of degradation must not be appliedFortunately, the doctrine is breaking down, and some ofthe universities are, in fact, seeking the powers wherewithto rid themselves of those graduates who act unworthilyof their gowns, and to place themselves in this regard ona level with the corporations. We would remind those

universities which do not seem too keen to acquire such

powers that if they wish the profession and the public toregard their graduates as " more than mere licentiates of

corporations " they must act accordingly and be prepared,if necessary, to degrade those whom they have graduated.We must pass hastily over Professor GREENFlELD’S inter-

esting and just remarks on the happy relations which subsistbetween the town and University of Edinburgh. It was not

perhaps, always so. There was a time when the town council

had too much patronage in its hands, though to its honourthe professors it chose were often men of the widest renown ;but now nothing can be more satisfa ctory than the pride ofthe Fathers of the city in the university, and their

cooperation with its authorities in maintaining its highprestige. Coming to the main points in the address,we may enumerate them broadly in the following way.Cultivate a high ideal of professional life and its

objects ; respect the confidences of the profession ; con-

sider how to convey truth to patients and their friends ;remember that sickness makes a man not himself—’’ the

higher his intelligence the greater his activity, the widerhis responsibilities the more intolerable to him is sick-

ness," as involving not so much physical pain as

mental, and the suffering of others dependent on him ;have patience under such circumstances with peevishnessand cultivate calmness, cheerfulness, and sympathy in

connexion with clearness, decision, and thoroughnessin directions and candour in speech. Like all goodmoralists, Professor GREENFIELD had to fall back on

the Scripture and say, "We that are strong ought to

bear the infirmities of the weak," and to quoteseveral other texts from the same indispensable source.

While vindicating the perfect freedom of patients to

choose their own medical man, he was emphatic inreminding his hearers that "one of the most stringentand primary rules is that no medical man should

under any guise, directly or indirectly, interfere with

the conduct of a case which is under the care of

another unless consulted by him." He denounced all

tendency to comment on the treatment and diagnosis of

others, insisting that no man can judge of a case he hasnot seen. At the same time he discouraged all local

jealousies and distrusts of professional neighbours. He

remarked that he had often been astonished that patientshad not enjoyed the advantage of consultation with medicalmen in their own neighbourhood, and found the explanationin mutual distrust. He enjoined on his hearers the duty of

thoroughness in investigating cases, observing most trulythat more mistakes are made by want of thoroughness than

by ignorance. Finally, he ended with a word of cheer tothose who had been backward in class and college distinc-tion, reminding his hearers that it is not ahvays the brilliantstudents who become distinguished in after-life.These are thoughtful words and cover more than may

appear at first glance. There is a disposition at present tocorrect the evils of the profession by legislation and by thedisciplinary action of the medical authorities. There is need

of these ; but, after all, the strength of the profession andits place in public estimation will depend on faithfulness toits own traditions, to its great unwritten laws, to its highestmorals. Reverence for patients, respect for their feelingsas well as for their health, will make us adepts in theinvestigation and treatment of their cases and in the

art of telling them all the truth that can do them

good or is consistent with our main duty-that of pro-

longing their lives. It will make us honourably reticent ofall family and personal facts which we come to know

professionally. Reverence for professional neighbours willmake us charitable in our judgments of them and quickto see in each of them a brother rather than a rival.

Reverence for ourselves will make us less discouragedby the vicissitudes of practice and more incapable of all

mean methods towards success.

Annotations.

SMALL-POX AND THE ROYAL ;COMMISSION ONVACCINATION.

- "Ne quid nimis."

THE existing prevalence of small-pox in the metropolisacquires additional importance, not only because it has

appeared at a time of the year when small-pox is, as a rule,least likely to become epidemic, but because at no timewithin the present generation has there been so much

tendency to disregard the law as to vaccination. This lattercondition of affairs has been brought about by the extra-ordinary delay in the issue of the report of the Royal Com-mission on Vaccination which was appointed in August,1889. We do not doubt that the preparation of all theevidence which has been brought before the Commission, bothby witnesses and by subcommissioners of their own appoint-ing, must take a considerable time, but it is absolutely im-possible that the minds of the Commissioners should not bemade up as to the various points which were submitted tothem when they were appointed ; and we see no reason whyParliament should not request the report forthwith; leavingthe question of evidence to stand over, as was done in thecase of the Royal Commission on Tuberculosis. In one

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sense, Parliament may not have the authority to make such ademand to a Royal Commission, but Her Majesty’s Ministerscan make it; and having regard to the present position ofaffairs the strongest possible pressure should be put uponthe Commission to hand in their report before they scatterfor their holidays. Even after it has been received there

will be quite sufficient delay in determining as to the

administrative and other details for giving effect to

any recommendations they may make as to alterations

in the law or in the methods of performing vaccina-tion. But what the public now want is an authoritative

statement as to whether vaccination does or does not afforda protection against small-pox and whether the operationought to be adopted and carried out with a view to suchprotection. We can conceive of no reason for delay in

making such a statement; and it is the more imperativethat an announcement as to this should now be made, sinceboards of guardians are constantly declaring that they areawaiting it before deciding whether to enforce the pro-visions of the Vaccination Acts or not. And in the mean-

time a population is growing up which is not vacci-

nated, and small-pox is spreading in our midst. We

regard the immediate position of affairs as involvingmuch gravity. If small-pox gets a hold on London beforeautumn it will be a very serious matter both for London andfor the provinces ; for anything like an epidemic in London hasalmost always been succeeded by the extension of the diseaseinto provincial towns and districts. Whilst, therefore, weare quite ready to acknowledge the extent of the task whichthe Royal Commission have had to perform, we cannotrefrain from pointing out, first, that they have had ampletime to come to a decision on the material laid before them ;and, secondly, that the present emergency is one that admitsof no further delay in letting the public know what conclu-sions they have arrived at on the principal matters submittedto them.

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SUGGESTION AND CRIME.

A RECENT murder in England elicited, on the trial of its

perpetrators, a solemn admonition addressed by the Court tothe purveyors of juvenile literature in which the robber andthe assassin are presented in an attractive rather thandeterrent light. The jury, indeed, saw a distinct nexusbetween the perusal of such literature and the crime of theyoung prisoners in the dock. Their finding has been

much quoted abroad, more than one Continental journalapproving of its tenour and recommending a similar

admonition on the part of tribunals sitting in judg-ment on delinquents of tender years. In Switzerlandthe Société des Medecins et Pharmaciens of Berne, at

a recent sitting on the prevalence of self-murder, came

unanimously to the following decision: ’’ For twenty yearsthe average of suicides in Switzerland has been 650, a pro-portion exceeded only in Saxony and Denmark. It has,besides, been matter of common observation in our greatcities, at longer or shorter intervals, that a certain number ofsuicides succeed each other coup sur eozip-suicides in whichthe first case often acts by way of suggestion, incitingindividuals predisposed to commit the same desperate act.It is therefore to be desired that in future the dailypress should refrain from reporting cases of suicide. Thisresolution will be brought under the cognisance ofthe Swiss Press Association." One of the leadingorgans of the Confederation, the Journal de Genève, com-ments favourably on this resolution of its medical confrères,and, with perfect justice, we believe, claims credit to itselffor having studiously and steadily excluded from its

chronique all cases of suicide committed within the canton.The policy thus recommended and acted upon has its

warrant not only from experience, but even a priora from

the study of psychology. The mimetic principle in man,particularly in those developments in which evolutionsees a distinct retrogression to a lower, more animal

type, has its roots deep down in the organisation, mentalas well as physical, arguing a pithecoid strain which

only awaits certain favouring conditions to manifestitself unmistakably in character. The epidemic of suicidewhich has been so much remarked of late has had its

counterpart in the epidemics of murder or manslaughter soapt to culminate in great social upheavals like that of theFrench Itevoliition or of the Parisian Commune in 1871.Lethal violence on both occasions was "in the air," andwhat Zola calls the homme-bête" became a ready imitator of"what the rest were doing, in other words, a "mission ofmassacre." We have small belief that such admonitions asthose of British tribunals or foreign professional associationswill have much practical force on contemporary crime,favoured as it notoriously is by fanatical estimates of theworthlessness of human life almost openly avowed. But

neither law nor medicine need be deterred from throwingits influence into the &cale of social and mental sanity bythe dread of having its "opinions" set down as merely"pious"

" or relegated to the limbo of the "academic."

INDIAN PILGRIMS AND CHOLERA.

A BILL was introduced by Sir Alexander Mackenzie at ameeting of the Supreme Legislative Council of India on thellth of last month for the regulation of pilgrim ships. TheBill is in the main the outcome of the recommendations ofthe Paris cholera conference of last year, and the newregu-lations will be put in force before the next pilgrim season.The Government of India has in this matter acted out of

deference to public opinion and has done its best to meet therecommendations of the conference, and we understand thatit may confidently anticipate the reception of strong repre-sentations from the Mahomedan community in India as tothe serious increase of the cost of pilgrimage which will beentailed by some of the provisions contained in this newPilgrim Ships Bill. We think that the Government of India istherefore in a position to demand that something should nowbe done by the Ottoman authorities on their part in regardto Kameran and the proper protection of the pilgrims atthat place. The Times of India, in a recent article onKameran and the Pilgrim Traffic, alleges that while, on theone hand, little or no evidence can be adduced in support ofthe theory that cholera epidemics at Kameran and the

Holy Cities have been originated by sea-borne pilgrimsimporting the disease from India, there is ample evidence,on the other hand, that the enforced detention of the

pilgrims on that island has the most injurious effects ontheir health, and that Kameran is itself a cholera-infecteddepot and a sort of hotbed for the development of that

disease, whether we regard it as endemic at that station or asan importation from India. Our Indian contemporary gives afull topographical description of the island of Kameran, ofthe lazaretto with its seven quarantine camps, of the so-

called sanitary arrangements, and of the disinfection andother methods of procedure pursued in connexion with theunhappy pilgrims during their enforced detention there, anddeclares that the whole quarantine process is a delusion andthat no precautions whatever are taken as regards the

pilgrims’ water and food supplies. The importance of thequestion is as great to India as it is to Europe. Thousandsof pilgrims make a long and perilous journey at a heavy costand great sacrifice to themselves for religious considerationswhich are to them of an imperative kind. If they do notactually die from cholera contracted at Kameran they areliable to be sent back to India in an enfeebled state of healthafter an enforced and long detention, with their mission unful-filled and their means exhausted. We quite concur with the

416

Times of India in thinking that common humanity, as wellas the safety of Europe, demands that England should take upthis question, and that the British Government should adoptsome definite line of action in regard to it. Kameran is, inits present condition at any rate, an unfit place for a quaran-tine station; there should be an International Board of Healthin the place of the present ineffective Ottoman Board, and injustice to our Indian Mussulman subjects and in return forthe efforts which the Indian Government has made to meetthe wishes of the Paris conference the treatment accordedto the Hajis from India at Kameran, Jeddah, and in theArabian desert requires to be thoroughly investigated andreformed. It is as important in its way as the question ofArmenia, and it may be urged upon the Sultan on the groundof protecting and safeguarding himself and his subjects inConstantinople and Turkey from epidemic cholera, aboutwhich he is known to be keenly interested.

AN ALLEGED CASE OF POISONING BY ARSENICAT SYDNEY.

A TRIAL that is probably unique in the history of legalprocedure has just been concluded in Sydney, and the casepresented not only features which have aroused the mostintense public interest, but also points of medico-legalimportance. The evidence given has been most voluminous,and in many points is contradictory. It would be impos-sible to summarise it all, but briefly the main facts

appear to be these. Early in March last a man named

George Dean was accused at the North Shore Police-

court, Sydney, of attempting to poison his wife. He wascommitted for trial, and the case was heard at the CentralCriminal Court by Mr. Justice Windeyer and a jury inthe beginning of April. The jury took some time to

consider their verdict, and the judge told them therecould be no doubt about the guilt of the prisoner.The jury then returned a verdict of Guilty, with a

strong recommendation to mercy. The judge pronouncedsentence of death. Popular feeling was roused in favourof the prisoner, public meetings were held, and the

sentence was appealed against and commuted to im-

prisonment for life. The agitation in favour of the prisonercontinued, and a petition was presented to Parliament forthe appointment of a Royal Commission to make full

inquiry into the case. The Government then appointed aRoyal Commission, consisting of Mr. F. E. Rogers, Q.C. (chair-man), Dr. F. N.. Manning, and Dr. P. Sydney Jones. Fromthe evidence given at the trials and before the Commissionit would appear that a few days after her confinementMrs. Dean complained of restlessness and sleeplessnessdue to neuralgia. Her medical attendant, Mr. Newmarch,prescribed a morphine mixture. She was then attackedwith vomiting, which he attributed to the medicine. This

was in the first week of January. On March 4th, when hesaw her again, she was suffering from vomiting and purging.Her temperature was subnormal. He attributed the attack i

to something she had eaten. The same evening a bottle containing some lemon syrup was brought to him in a

mysterious fashion, and he was asked to get it analysed. It was then suggested that Dean was poisoning his wife. ]The syrup was analysed and found to contain 1 3/4 grains of arsenic and 1½ grains of strychnine. On the 10th Mr. i

Newmarch cut a fiscal stain out of Mrs. Dean’s night-dress iand had it analysed. It contained traces of arsenic. Duringand subsequently to the trial at the Criminal Court Mrs. aDean developed peripheral neuritis. No satisfactory evidence i

was given as to where the poison was obtained or to connect any person with its purchase, and the only evidence to con- i

nect Dean with the poisoning was that of his wife and her i

mother, to the effect that they had seen him mix a powder iwith some of the medicine, and that he prepared and gave c

her all her food and medicine, and that tea and groats and! other articles of food given her by Dean had a bitter

, taste. Mr. Newmarch and the medical men who sub-

sequently attended Mrs. Dean at the hospital had no

doubt that she had suffered from arsenical poisoning, thoughthe defence suggested that the symptoms might have beendue to influenza. A great deal of medical evidence was

given on this question and as to the effects of arsenic, andespecially as to the effects of arsenic combined with strych-nine, and statements were made that the two drugs wereantidotal to each other. Dean had previously borne anexemplary character, but evidence was given to the Com-mission that in his youth he had been in gaol. Evidencewas also given that Mrs. Seymour (Mrs. Dean’s mother)had been a notoriously bad character, had kept a shopwhich was practically a house of ill fame, and hadbeen the associate of criminals. The main defence wasthat there was no evidence to show that Dean poisoned hiswife except that of his wife and mother-in-law, and thatthere was a conspiracy on the part of the mother and

daughter to accuse Dean of the crime and so get rid of him.The Commission was not unanimous in its report. Mr.

Rogers, the only legal member, upheld the decision of thejury and the opinion of Judge Windeyer that Dean’s guiltwas not open to question. The two medical members

reported that there was doubt whether he administered thepoison and recommended that he be released, and releasedhe has been accordingly. We are not aware of any pre-vious occasion upon which the decision of legal authoritieson matters of evidence has been reversed on the recom-mendation of medical men.

THE ALLEGED INCREASE OF INSANITY.

IT is eminently satisfactory that the Lunacy Commissionersare beginning to recognise the importance of age incidencein the consideration of the statistics of insanity with a viewto the determination of the problem whether the constantincrease in the number of the insane under treatment in

England and Wales really signifies an increasing prevalenceof lunacy, or rather of occurring cases of insanity. In theirrecent annual reports it is true that the Commissioners haveconstantly expressed their opinion that the large increase inthe number of known lunatics is mainly due to causes otherthan an increase in the prevalence of insanity as an activedisease. They have, however, until now turned a deafear to the urgent appeal for statistics of the ages of the

patients annually admitted to the lunatic asylums, and ofthe ages of the patients who die year by year in

those asylums. We are glad to note in the recentlyissued report a first instalment of such age statistics,which, if continued for a series of years, and if amplified,will in a few years afford the means for throwing much lightupon this important and interesting problem. It is pointedout that in recent years there has been a marked increasein the number and proportion of admitted cases of I I mentaldecay resulting solely from old age." In proof of this theCommissioners show that in 1883 the admissions to asylumsof persons aged upwards of sixty years were equal to 12-5per cent. of the total admissions; in 1888 this proportionhad increased to 13’2 per cent.; and in 1893 it had furtherincreased to 14’7 per cent. These statistics are based uponinformation contained in the annual reports issued by countyand borough asylums, and conclusively prove that the casesadmitted above the age of sixty years have increased at afar more rapid rate than the admissions under that age.These cases represent, probably, to a large extent transfersfrom workhouses to asylums, but from whatever cause theincrease arises it can scarcely be seriously asserted that thisincrease of cases of senile mental decay represents an increaseof true insanity. These figures, moreover, throw some light

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upon the age incidence of the persons returned in Englandand Wales as mentally deranged at the three Censuses in1871, 1881, and 1891. The ratio per 1000 of the Englishpopulation returned as mentally deranged under the ago offorty-five years was 2-24 in 1871, 2-29 in 1881, and 2-26in 1891. Thus the ratio of insanity to population at theseages remained practically stationary during this period oftwenty years. Above the age of forty-five years, however,the calculation of the ratio of insanity gives very differentresults; the ratio was 6-35 per 1000 in 1871, 7-40 in 1881,and 8-02 in 1891. In the absence of information as to the

ages of cases admitted to asylums it was impossible toascertain how much of this increased incidence of mental

derangement upon elderly persons was due to what maycorrectly be called the accumulation of cases caused

by improved treatment of the insane in asylums,and how much to an increase in the number of

admissions of cases of senile dementia. The figuresgiven in the Lunacy Commissioners’ last report establishedbeyond doubt the steady increase, both actual and relative,in the admission of cases of so-called insanity above the ageof sixty years. The important bearing of these figures inthe direction of disproving the reality of the alleged increaseof insanity in this country will, it may be hoped, induce theCommissioners to give more complete statistics of the agesof the annual admissions to all asylums for the insane infuture reports.

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ABDOMINAL SECTION FOR PUERPERAL a8EPT)C/EM!A. 1(

THE July number of the American Journal of Obstetricscontains an interesting communication by Dr. J. M. Baldyon Abdominal Section in Certain Cases of Puerperal Septi-cæmia. He distinguishes between cases in which there is

suppuration and cases where there is infection of the

Fallopian tube, the ovary, and possibly of the peritoneumwithout any formation of pus, but with exudation recognisableby physical examination. A case is given as an example ofthe former class in which a patient was very ill after

delivery for several weeks, the uterus was subinvoluted,and to the left side of it could be felt a large,boggy mass firmly adherent, tortuous, and tender.An abdominal section was performed, and the swelling,which proved to be the left Fallopian tube and ovary dis-tended with pus, was removed, the patient making a rapidrecovery. So far there is nothing remarkable in Dr. Baldy’spaper. It is well known that ovarian tumours, which mayor may not be suppurating, are frequently noticed for thefirst time during the lying-in period owing to the size of theabdomen remaining greater than is normal after delivery,and the proper line of treatment for such tumours withina few weeks of delivery is the same as at other times. Inthe second group of cases, where there is no pus, though exudation can be felt and the patient is acutely ill, Dr. Baldy admits that it is clinically a most difficult matterto decide whether or not pus is present, but if the

opinion be come to that there is no pus thenno operation is indicated. In cases of general puru- lent peritonitis, from any cause whatever, Dr. Baldydoes not believe that any line of treatment, operative or

other, has ever saved the patient; but, inasmuch as adiagnosis of general peritonitis may sometimes be madewhen really the peritonitis is more or less localised, indoubtful cases Dr. Baldy advises operation. Turning thento the cases of puerperal septioasmia grouped as pelviccellulitis, the question again arises as to whether thereis or is not pus. Where there is not pus then as a

general rule no abdominal section is likely to be required ; where, however, there is pus, although it is admitted that the whole extent of infected and suppurating connective

tissue cannot ;;removed, Dr. Baldy advises total hysterec-tomy, not only on account of the amount of diseased tissueso removed, but because the affected area is so thoroughlyopened up by the operation, and placed in a favourable con-dition for drainage. So far the cases under considerationhave been those of puerperal septicaemia where there is adefinite swelling to be felt that may be due to either sup-purating cellulitis, or to salpiugitis and peritonitis, withaccumulation of pus in the Fallopian tubes or ovaries. There

is, however, a group of cases of puerperal fever where noswelling is to be felt in the pelvis and where absorption is

taking place from the interior of the uterus itself. In this

group, after trying intra-uterine douching, curetting, theapplication of pure carbolic acid, packing with iodoformgauze, and the like, without improvement soon appearing,Dr. Baldy also recommends abdominal hysterectomy, thoughhere he thinks removal of the uterus as low as the internalos sufficient. He has collected nineteen cases of hysterectomyduring the puerperal state performed by American operators.Twelve of the patients died and seven recovered. Dr. Baldythinks sufficient success has been obtained to warrant a

further and more general trial of abdominal hysterectomy inthe special class of cases under consideration, though headmits the field for hysterectomy in puerperal cases is not alarge one.

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PRESCRIBING DRUGGISTS.

THE prescribing druggist is like the poor for whom he

prescribes, always with us, but the latest instance reportedexhibits some " features of interest " rather different to the

usual run of these cases. A child named Clark, suffering frombronchitis after measles, was attended by the druggist, whogave it some harmless powder. As the child did not getbetter he told them to send for a medical man, which

they did, but the child died. Mr. Perdue, the druggistin question, said he had attended the sick, the dying,and the bereaved for six years. He never got anyfees, but he added: "I I get my living by convertingtea-leaves into anything. It would surprise anyone to

see what I make out of tea-leaves." Mr. Perdue is

evidently well within sight of the philosopher’s stone. We

only trust that tea is not among the things that he convertstea-leaves into, for in certain parts of London a large trade is,we believe, done in tea-leaves. They are rolled, dried, faced,and sold as fresh tea. However, this trade is less harmfulthan Mr. Perdue’s by-occupation of prescribing, although, asthe coroner said, " Anyone may prescribe at their own risk."

SUICIDE IN ITS MEDICAL AND ITS MORALASPECTS.

IT has been noted elsewhere that a tendency to suicide hasrecently been somewhat unusually prevalent. In THE LANCETof July 28th, 1894, we suggested that this tendency might becapable of partial explanation on physical grounds, and in alater issue (Aug. llth) we published a letter by Dr.

Alexander Haig bearing upon the same subject. The

regular, though happily never frequent, connexion betweensolar heat and this form of crime has been repeatedlyobserved, and may, without undue straining of logicalconditions, be accepted, at all events as far as it goes, asa working hypothesis founded on accurate observation.When we go further and seek to explain the hypo-thesis itself, however, we are still conscious of the insuffi-

ciency of our data. The theory by which Dr. Haig wouldassociate mental depression with blood vascular tension dueto uric acid is indeed helpful in its measure, as it is certainlyingenious. The measure of assistance towards a sufficient

explanation is nevertheless in both cases very meagre. It isevident that in the case of most persons a wide desertof despondency intervenes between the state of mind which

G 3

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corresponds to a hard pulse and overladen tissues and thflast fatal folly of despair. Save in the case of insane 01weak-minded persons, it is hardly possible to conceive thatmen can be impelled to suicide by purely physical conditions,which are, after all, so common as hardly to be regarded aabnormal except by the scientifically educated mind. Wewould by no means overlook the necessity of treating thesecases by appropriate means, but we are none the less assuredthat the reckless will which induces men to convert a

weariness of life into a purpose of self-destruction doesnot depend upon mere atmosphere or mal - excretion.Where they are free to operate, the reserves of moral sense,thought, and resolution have either been previously ex-

hausted or have not been drawn upon. A feeling of

personal loss or a morbid fear of such has obliteratedthe sense of human relationship. The interest of dependentor associated neighbours and of relatives is forgotten.Self-love, not social duty, is the impelling force. We havenot much hope that persons in this mood will be greatlyinfluenced by changes of weather or by purely physicaltreatment. We would rely more upon the full and frankassertion of the duty and utility of all human beingsto each other and to the Providence essentially friendly tomen which called them into being. Suicide is, after all, amoral failure, an evidence of the mastery of mistrust, an actof rebellion against the authority of patience. Obviouslyno drug, no social reform even, can effectually cure it, unlessthey be aided in the first place by a frank and full recogni-tion of man’s moral relation and responsibility.

THE CASE OF SURGEON LEA, R.N.

IT will be remembered that in an annotation in THELANCET of June 22nd last we referred to the case of

Surgeon Lea, R.N., and said that, considering his hithertounblemished reputation, and the very unsatisfactory andincomplete nature of the evidence adduced at the court-

martial held on this officer at Sydney in April last, we weredecidedly of opinion that the matter called for further care-ful investigation by the Admiralty in this country. Weare glad to learn that Surgeon Lea’s case is underthe consideration of the Lords of the Admiralty and thelegal advisers of the Crown. The circumstances were

of an altogether exceptional and curious character, andas far as we could judge from the published reports of thecourt-martial it seemed to us that Surgeon Lea had beenhardly dealt with. We consequently await the result of thedecision that will be, or has already been, arrived at withmuch curiosity and interest. Surgeon Lea was a distinguishedstudent of University College Hospital, and a former pupilof the present President of the Royal College of Surgeonsof England. He entered the Naval Medical Service in

August, 1883, taking the first place, and has consequentlytwelve years’ service. -

FOR THE SILLY SEASON. 1.THE sea serpent has at last been caught, or rather cast a

ashore and photographed, but though associated with wild (

legends there has never been any reasonable doubt as 1to his existence. But there is a wilder form of credulity 1which comes up every year in the shape of stories of I

people who " bring up" live animals, and the followinginstance appears in the columns of the Star, which must I

be either extremely credulous or have a painful dis- t

regard for the truth. The story comes from Silvertown- f

11 sex oriente semper aliquid novi." Such stories as these r

always come from the East-end, and the present one is 1

to the following effect. A lady in Silvertown had suffered a

from spasms, diarrhoea, and sickness for some time. Two Smedical men and a hospital were tried in vain. She then con- c

suited another medical man, who, with a rapidity of diagnosis t

which does him infinite credit, said " By Jove, it’s a worm,"and proceeded to administer quinine and nitric acid. After

three days of this treatment, during which the patientendured much suffering, she felt something rise in her throat,and, putting her finger and thumb down her throat, pulled offthe head of a newt, which was followed a few moments later

by the body and tail, eight inches in all. According to the<SM’, the medical man’s explanation is that it was swallowedeither in water or watercress, and the process of getting ridof it was as follows : " The acid in the quinine irritated theanimal, causing it to jump about and tickle the bronchialtubes. The tickling produced the vomiting, and the vomitingproduced the eft." We must confess to serious doubts asto the truth of this story. A newt eight inches long isalmost unknown in England, and we think it may well beclassed with the story of the bees or wasps which werevomited by a harvester in Wales some short time ago, andupon which we commented in these columns. But nothingwill ever induce a certain class of patient to disbelieve inthe existence of living animals inside them.

THE DIFFUSION OF SMALL-POX.

THE epidemic manifestation of small-pox through whichLondon is at the present time passing would seem to

have reached its highest point for the moment. Thecases newly arising in the fourth week of July were 98in number, and though this number gave place to 90 in thesucceeding seven days the attacks coming to light lastweek were but little over 50, the registered deaths in thesuccessive weeks being 1, 1, and last week 3. As mighthave been expected, the patients for whom the MetropolitanAsylums Board found they had to provide rapidly increased,and in the four weeks ended last Saturday were respectively23, 115, 60, and 54 ; whilst the cases remaining under treat-ment in their hospitals and at Highgate Small - poxHospital rose from 89 to 199 in one week, and thenceto 237, and last Saturday to 273. At the last meetingof the Asylums Board the fact came out that, whereasbhe earlier cases were in the main from sheltersMid the like, the later manifestations were largely fromMnong the resident population, a sign of deep signifl-3ance as tending to show that the disease had fastened)n the portion of the community permanently located in

London. In these circumstances Gore Farm Hospital wasJleared of its scarlet fever patients and reserved wholly foronvalescent small-pox cases. The application of WestElam to be allowed to make use of the Board’s accom-nodation was heard, and regret was expressed that the

neans at the disposal of the Board did not admit ofts being granted. But very fortunately the disease hasiot made any great inroads on that borough yet, the

)ases in recent weeks being few in number. The deaths

’egistered in the metropolis last week as occurring from;niall-pox were 2 in vaccinated adults aged over twentyrears and 1 in an unvaccinated person of the like

Lge period. Two belonged to Whitechapel and 1 to Shore-titch sanitary areas. Districts contributing cases to

he hospital ships last week and during the presentveek were, among others, Whitechapel, Mile End,’lumstead, Lambeth, Wandsworth, Paddington, St. George’siouthwark, and St. George’s-in-the-East, the western and.orthern areas being generally free from the disease. Inhe home county of Essex there were, in addition to theew cases at West Ham and Leyton, some attacks at Leigh,ot far from Rochford. In the Midlands there is butttle to chronicle, one or two places in Staffordshirend Derbyshire being slightly affected ; but westward thealop County Council have had before them the historyf an outbreak of a localised character at Oswestry,raceable to a case found at a common lodging-house,

419

Subsequently 5 other persons residing in the same

house were found to be suffering from the disease, as wasan innkeeper’s wife, infected probably by the originalcase, the patient having conversed with her in the inn.

Measures of disinfection have been taken, and personslikely to have been in danger of infection have been

kept under observation. In the last week of July therewere 4 cases heard of from Manchester, 3 from Openshaw and1 from Hulme, all being removed to the Clayton Hospital ;and last week 2 other cases were reported in the city.A death from the disease was last week registered at

Liverpool, and 2 deaths at Oldham, where the disease is

again on the increase, several cases having occurred

there and in the adjacent township of Chadderton. The

outbreak at Thornhill is causing more anxiety, some alarmhaving been created by the rapid succession of 4 deaths,and temporary hospital accommodation has been decidedupon, as well as the expenditure of E3000 on a permanentstructure. Much discontent has been felt at the alleged dis-charge from the Southport Convalescent Home of a manwho was found to be suffering from small-pox. A

family of six members has been moved from Stainland,near Halifax, to the Hollins Hey Hospital, and a case

has been recorded at the village of Mytholmroyd. In

Dublin the news for the week ended Aug. 3rd is

to the effect that only 6 cases of small-pox were admitted tohospital, against 15 discharges, leaving only 25 acute casesunder treatment, as compared with 36 in the preceding week.Of 3 deaths registered in the week the patients wereregistered as vaccinated, unvaccinated, and " doubtful as tovaccination." The former and latter were in adult life ; theunvaccinated person was aged between five and twenty years.

MALINGERING AND MIRACLES. IA CASE has just been heard at the Paris Assizes which fl

is extremely interesting to the physician, the theologian, C

and the criminologist. It is that of a man who for some a

five years or more deceived the greatest physicians in Paris, 1

including Charcot, into believing that he had commencing 0

locomotor ataxy. After having been cauterised and s

" suspended," neither of which treatments he liked, he a

eventually arrived at Lourdes, where he was miracu- i]

lously "cured." In 1891 he robbed the Lourdes fathers s

of 400 francs, and returning to Paris was admitted to v

an asylum as suffering from persecution mania, and from hthis institution he stole some 2000 francs. Being arrested, F

it was discovered that he was a malingerer of ’’ astounding 4skill," and was sentenced to four years’ imprisonment andten years’ police surveillance. The whole question of

modern miracles is an exceedingly difficult one. We shouldbe the last to maintain that they cannot happen, but o

whether they do is, we believe, queried by Roman nCatholic theologians as well as by others. This case o

of locomotor ataxy may be catalogued along with n

those which are cured by a certain patent medicine- ai.e., the disease never existed ; but in this age of aunbelief it is a pity when anything occurs to sap the s

religious element in man. These kind of failures react in a lvery harmful way upon the hysterical paraplegics who are 11really ill, if only functionally, and who, if they can only be ninduced to believe they will be cured, are so, at Lourdes or tany other place which has the requisite mystical qualities. a

MEDICAL SERVICE OFFICERS AND THE JMEDICAL REGISTER. "

WE think that Brigade-Surgeon-Lieutenant-Colonel Temple t(

Wright has done a good service to members of the medical n.

departments of the army and navy by calling attention to a o

subject about which he recently moved a resolution at a ii

general meeting of members of the British Medical Assouia- b

tion. The resolution, which was unanimously passed andwill be forwarded to the President of the General Medical

Council, was this:-"That this meeting desires to submit a respectful sug-

gestion to the General Medical Council that every medicalofficer whose name appears in the Na1’Y List, the Army list,and the Indian Army List shall be considered to be still aliveand at the post opposite his name."From the nature of their duties and their conditions of lifemedical officers of the respective services, unlike civilians,have no fixed place of abode, and are more or less wanderers.It must consequently happen that letters sent to their

supposed addresses sometimes fail to reach them, andwhen this occurs they may find, to their astonishmentand possible grave inconvenience, that their names havebeen struck off the Register under the mistaken assump-tion, for example, that they are dead. The appearanceof their names in the army and navy lists is an official

guarantee, however, of their being alive, if not actuallypresent at their respective posts, and may be safely reliedupon as correct. Sir Richard Quain had recognised thethoroughly reasonable nature of the representation, andsuggested that it should be embodied in a resolution andsubmitted to the General Medical Council by the BritishMedical Association, as he very rightly considered that itwould materially facilitate the conduct of official business bythe Council, of which he is the President. This has accord-

ingly now been done, and Brigade-Surgeon-Lieutenant-Colonel Temple Wright may be fairly congratulated on thepractical nature of the step he has taken in the matter.

AN EXHIBITION OF DRUGS AND CHEMICALPRODUCTS.

PHARMACEUTICAL and practical chemists in general willfind interesting material for their inspection at the Drug,Chemical, and Allied Trades Exhibition which is to be heldat the Royal Agricultural Hall, Islington, on Sept. 10th,llth, 12th, and 13th. Whatever may be the pecuniary resultsof these displays they are undoubtedly most useful in thespreading of correct information with respect to the variousarticles and processes on view. The experimental chemist isincessantly placing new substances at the disposal of the pre-scriber, many of whose familiar present-day medicamentswere altogether unknown twenty years ago, and pharmacistshave not been slack in devising convenient and palatablepreparations. The offices of the exhibition are at

42, Bishopsgate-without, E.C.

I THE DIAGNOSIS OF SMALL-POX.

A PHYSICIAN with exceptional experience of small-pox andof the common errors of diagnosis in reference to it can dono kinder thing than to give his brethren the benefit of hisobservation. This is more especially true at a time when themuch-dreaded disease threatens to resume activity. The

abeyance of the disease for years all over the country,and especially in the metropolis, makes such a communicationstill more valuable. The growing efficiency of sanitarypolice checks the spread of small-pox more and more, andmakes it possible for many students and even practitioners ofmedicine never to have seen a case. The effect of vaccina-tion in modifying the disease when it does occur is suchas to make an actual case often differ much from the

typical case described in books. Under all these circum-stances the shrewdest practitioner will be most grateful fora few points of guidance in diagnosis where it is so seriousto be wrong and so important to be right. We would directall that are so minded to a communication in ’1 nL LANCETof July 20th ]),y Dr. H. Meredith Richards, medical super-iiiten(leiit of the City Hospitals, Birmingham, whose lot it hasbeen to see not only the 3000 cases sent to the liospitals, but to

420

visit on behalf of the medical officer of health every casenotified as "possible small-pox."

" The points of diagnosisare given with admirable clearness, and not only withoutany of the airs of superior knowledge, but with amplerecognition of the difficulties of the duty and frank admissionof the care with which it is generally discharged.

INTERCOLONIAL MEDICAL CONGRESS OFAUSTRALASIA. I

WE have received a notice from the secretaries that thedate of this Congress has been altered from Feb. 17th toFeb. 3rd, 1896. Another alteration has been made in the

arrangements as originally announced in our columns inthe formation of a subsection of the Section of Surgery toconsider diseases of the eye, ear, and throat. The secretaryfor this Section is Mr. H. L. Ferguson, High-street, Dunedin.The names of the other secretaries of Sections will be foundin our former notice.

___

THE HONOURS TO THE STAFF OF THESHAHZADA. ii

WE note in the daily press that Lieutenant-Colonel A. C. (

Talbot, C.I.E., has been promoted to the Knight-Com- i

mandership of the Indian Empire, and Mr. Thomas Acquin I

Martin, the Agent to the Government of Afghanistan, has 1received the honour of knighthood, in recognition of their f Eservices during the visit of the Amir’s son to England. fWe cannot but think that the extension of some similar c

honour to another member of the Shahzada’s staff, who is s

an officer of the Indian Medical Service, would have been -*

appreciated by the medical profession, whose labours on rsuch occasions are too often forgotten. Dr. Leahy must rhave had to bear the weight of very serious responsibility r

during the protracted visit of the Prince, and the omissionof his name from the list of honours strikes us as an unfor- t

tunate and regrettable incident. f

____

s

AT a meeting of the Strand Board of Guardians held on r

Tuesday, 13th inst., a resolution was adopted in favour of tplacing the Salvation Army shelters and all similar institu- s

tions under the Common Lodging-house Act, having in view r

the spread of small-pox and other infectious diseases from rthese shelters.

___ ?. s

SIR E. J. REED has again written to the Times expressing g

a hope that the new Government may see their way to release tDr. Cornelius Herz from the condition of arrest in which he phas been for the last two and a half years. The accounts of 1,

Dr. Herz’s health remain very gloomy. I’&mdash;&mdash;&mdash; ** c

SOCIETY OF MEDICAL PHONOGRAPHERS.

THE first general meeting of the members of this society azwas held on July 30th at 20, Hanover-square, London, when inthere was a very fair attendance of members and visitors, the di

latter including Sir Henry Howorth, M.P., F.R.S., and Sir th

William Broadbent. The chair was occupied by Dr. G-OWBBS, F.R.S., first president and founder, who was supported by inDr. Gray (Oxford), Treasurer, and Dr. Neil, Secretary. he

Dr. GowERS, in his address, stated that the object of the si(

society was to promote the work of their profession, alike in re;

medical science and its application in practice, by freeing it hefrom one grave hindrance which the present has inherited co

from the past. Writing to-day is what it was when Caxton inmade it mechanical, with no attempt at improvement until gr,the present generation. But now a method of writing isavailable in which simplicity of symbol corresponds to tosimplicity of sound, and which needs, with a greater aD’average of legibility, only one-third of the time and less a&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash; pe

1 THE LANCET, vol. ii., 1894, p. 1115.

than one-third of the labour of ordinary writing.Science rests on observation, which without immediaterecord is of little value ; not only is memory inadequate,but record at once reveals unsuspected imperfections inobservation. Compared with longhand, shorthand permitsin a given time twice the amount of record, while leavingtwice the time for observation. The latter must be moreminute and more precise to permit the fuller record, and thefirst effect of the use of shorthand is on the quality of work.The constant use reacts on the worker, and it is again foundtrue that "writing maketh an exact man." In the dailywork of the practitioner, which is peculiar in being a formof personal science-knowledge constantly increased byobservation-record is most important. It changes vagueimpression into definite knowledge and increases that

ability which is so important to those who suffer. Formost practitioners record is practically impossible with long-hand ; it is possible for all with shorthand. The service ofthis, however small its influence may be thought, multi-plied by numbers, becomes incontestably important. Thechief means adopted by the society is the issue of medicalliterature in lithographed phonetic shorthand-a monthlyperiodical and other publications. But the facility ofwriting, and secure legibility, which phonography affords,have led to useful interchange of thought in other ways.The society, started last December, has now 165 members,of whom 25 are students and 140 practitioners. It is

important that the student should be familiar with short-hand before beginning professional studies, for it helpshim in every form of work. It is much to be desired thatshorthand should be made an extra subject in the entranceexamination. It needs but a limited and short expenditureof time, and this is soon regained. It can, however, bequickly acquired at any age. It is now taught at manyschools, but its subsequent use is not sufficiently encouraged.It may seem strange that the value of this mode of simplewriting-quick, easy, and secure-should first be thus

recognised by members of the medical profession, but it isnoteworthy that, in their hands, its use will probably havemost direct influence on the welfare of others.A letter was read from General Sir C. WILSON, speaking of

the recognised value of shorthand to staff officers, and onefrom Dr. J. H. GLADSTONE, who has used shorthand con-stantly in science since 1846, and invariably employs it forrecording observations and preliminary writing.The Bishop of HEREFORD wrote : " The establishment of

this Society of Medical Phonographers is an event of no

small importance. It is obvious that it puts a new instru-ment into the hands of the observer, an instrument whichmust be specially valuable when you have to deal withsubtle and quickly changing phenomena. I may say how

important your action seems to me because of its influenceas an example. It will do a great deal to popularise thestudy in all our higher schools, as it will help to brush awaythe prejudice that shorthand is chiefly useful for tradepurposes and may be neglected by the profession withoutloss." "

Sir HENRY HOWORTH, M.P., F.R.S., in responding to thePresident’s invitation, said he was distinctly one of thatclass who deplored most desperately that he was not taughtshorthand as a boy. In writing his books his great despairand difficulty had been the copying down verbatim in theordinary longhand the material pertinent to the subject.Shorthand would have spared his eyes and saved both timeand temper. He felt so strongly on the matter that he wasinsisting on his boys learning the art. He had travelled in

dangerous and difficult countries, where he found one ofthe greatest difficulties was our cumbrous writing. Hereferred to the great use made of the art by the Presidentin the compilation of his published works, and went onto speak of the value of the phonetic principle, whichhad enabled Mr. Reed, at the sittings of the Opium Commis-sion in India last year, to accurately record and afterwardsread over the evidence of two Brahmins of whose languagehe knew nothing and whom he had never seen before. Inconclusion he referred to the President as a great evangelistin the cause, and spoke in flattering terms of the Phono-r;raphic Quamterly Review.

Sir WILLIAM BROADBENT said he was present to testifyto his sympathy with the work of the society, and that heagreed with every word of the presidential address. He,also, had to look back with regret to the fact that he did notpersevere sufliciently with shorthand to make use of it, buthe recognised to the full the utility of the art for taking