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is never over.anxions to parade his qualification to the

world. How deeply this is rooted in the minds of the classreferred to is evidenced by the late memorial presented to theCollege of Physicians, and by the numerous letters publishedin the pages of this journal. As the surgeons in general prac-tice in this kingdom are the family medical advisers to nine-teen-twentieths of the population, and occupy an importantposition in society, it is natural that they should aspire to beassociated with the College in Pall-mall. The propositionwhich has been broached in our columns that the members

of the Society of Apothecaries should be admitted ad eunde1nin that College is deserving of serious consideration. We

would not maintain that the sole apothecary should be en-titled to this distinction, inasmuch as he has passed no sur.gical examination-a test which is required of the licentiate ofthe College of Physicians. But in the case of a doubly qualifiedpractitioner-that is, a member of the College of Surgeons anda licentiate of the Apothecaries’ Society, or of any other

recognised medical corporation-there seems to be no validreason against his claim. It would tend greatly to elevatethe position of gentlemen so circumstanced, and if carried outwould give an amount of power and influence to the Collegeof Physicians which it would be difficult to over-estimate.

That the College is not indifferent to the possession of thispower we have had sufficient proofs in the efforts which it

made some years since to form with the College of Surgeons a

joint board for the examination of candidates for generalpractice. We advocated this plan at the time it was proposed,and think it a misfortune that it was not carried out. The

institution of a grade of licentiates of the Physicians’ Collegein Surgery and Medicine did much to remedy the want, and theCollege of Physicians has now, by judicious management, an

opportunity of rendering a great service to the profession, andof materially enhancing its own importance. Are there anysufficient grounds for refusing the admission of fully-qualifiedpractitioners to the ad eundem licence ? The progress of opinionand events would seem to show that this admission must even-

tually be granted. In every way it would be advantageous tothe recipients; in many ways advantageous to the donors.Whatever can tend to simplify the titles of medical practitioners,and to separate them from all connexion with a trading body,must pri1nâ facie be desirable, The College would do well topause before they reject the prayer of the memorial lately pre-sented to them. Their concession would be a step in the rightdirection. It would gratify the wishes of a very numerous and

important class, and place the College in a position which itought long since to have occupied.

Medical Annotations.Ne quid nimia."

PSYCHOLOGICAL MEDICINE,

p’ Tss following are the agenda for the annual meeting of thisAssociation, which will take place on Thursday next at theRoyal College of Physicians, Dr. Henry Monro presiding.After the meeting of the general Committee at ten A.M., themorning meeting of the Association will be held, which will beopened with an address by Dr. David Skae, the rearing pre.sident. The report of the Committee on the SuperannuationClause will then be read. followed by general business and a

revision of laws. Resolutions will be proposed by the homerary secretary, Dr. Harrington Tuke, and by Baron Mundy.M.D. The following are the terms of Dr. Mundy’s proposedmotion -" That in the interest of the present and futureconditions of asylums, and in that of theoretic and practicalprogress in phrenopathy, a special committee shall be appointedto draw up a report on the following questions; and that thesame shall be laid before the next annual meeting for generaldiscussion and final resolution :-

" 1. "Does the present system in the cure and treatment ofthe insane, and in the management of asylums, such as it existsin England as well as on the Continent, answer in every respectsatisfactorily to the exigencies of medical, social, and eco-

nomical science of our time; and does this system attain itapractical aim in the cure of curables and the welfare of in-curables ?

"2. Is there no defect at present&mdash;(<t) In the general lawfor the insane, including the medico-legal part of it ? (b) Ingeneral, and especially in clinical instruction in medical science*(c) In the administrative and executive form of control overasylums as now practised both on the part of Government andof other corporations?

’’ 3. What practical propositions can be recommended to ourAssociation by the members of this committee to redress thesad conditions which necessarily must be reported in answer tothe first and second questions, and how can these proposals becarried out ?"

Dr. Tuke will move to the effect, that the present legal testof responsibility of the insane is inconsistent with our know-ledge of insanity, aiming especially at the defect in the testwhich consists in the " knowledge of right and wrong." Theafternoon meeting will be held at two when the followingpapers will be read:-Dr. Morel, of the St. Yon Asylum, Rouen," On the Present State and Future Prospects of PsychologicalMedicine ;" Dr. E. Toller, " On the Advantage of the CottagePlan over all others for the Accommodation and Treatmentof the Insane;" and Dr. Lockhart Robertson, "On AsylumDietetics." Drs. Watson (President of the College of Phy-sicians), Tweedie, Griesinger (Zurich), and Kirkbride (Phila-delphia), will be proposed as honorary members. The annualdinner of the members and their friends will take place at theCrystal Palace at seven P.M. Dr. Monro will hold a conver-sazione on Wednesday evening at his residence in Cavendish-square. -

THE CHAIR OF SURGERY IN EDINBURGH.

As might be anticipated, the contest for this chair is veryanimated; and the Curatorial Court, who are the electors, arelikely to be much agitated by the friends and supporters of therespective candidates. The candidates are Mr. Spence, Mr.Lister, and Dr. P. Heron Watson. Mr. Spence and Mr. Listerare both so well known throughout the profession, that it is

unnecessary to do more than mention their names. Dr. Watsonis a son-in-law of the late Professor Miller, and assisted in therevision of his late edition of " A System of Surgery;" he hasalso lectured for the late Professor. He has a very good reputa-tion and many friends, but will probably not be considered asof the same hue as either of his competitors. Mr. Spence is agood operator, a surgeon of great experience and ability, andhis claims will find large support. Mr. Lister, on the otherhand, is known both as a surgeon and as a physiologist allover Europe, and his name would add lustre to the University.The Croonian lecture which he last year delivered before the

Royal Society was a remarkable evidence of his great acute-ness, physiological skill, and power of thought. His recent

contributions to practical surgery in the treatises on Amputa,-tion in " Holmes’s System of Surgery,"are of the highest orderof surgical writing. Mr. Lister is at present Professor of Surgeryat Glasgow, and the professional opinion of his distinguishedmerits and consequent chances of success is significantly shownby the stir which is already being made in view of the vacancyia that chair which would necessarily follow his election. Dr.B .B1acl&oslash;od, of Glasgow, is amongst the probable candidates for

47

Abat appointment. The " Curatorial Court," who elect to theEdinburgh professorship, consists of Sir David Brewster, the.BSghtHon. Mr. Milner Gibson, M.P., the Chancellor of thEExchequer, Mr. Adam Black, M.P., Mr. David Muir, M.P.;the Provost of Edinburgh, and Baillie Johnstone. The chairis worth about X700 or &pound; 800 a year.

OXFORD EXAMINATIONS IN MEDICINE.

THE papers given at the recent examinations for the degreeef Bachelor of Medicine are lying before us; and some of themare so excellent, and exemplify so well what in principle anexamination should be, that we would quote them as models.In addition to excellent papers having reference to physiology,pathology, and therapeutics, the following practical questionsare set :-Make such a dissection of the organ put before youas will show the different structures of importance which itcontains in s;7M. Write a detailed account of the anatomical

preparations labeled 1 and 2. Examine the solutions putbefore you, and labeled 3, 4, 5, and 6, for sugar, albumen, andbile. Give an account of the processes you employ in testingfor each of these substances. Place under the microscope apiece of muscular tissue from the organ you have dissected, andstate in what points it differs from such muscular tissue as isfound in muscles attached to the limbs. Give an account ofthe object placed under the other microscope and labeled 7.To what natural orders do the plants labeled 8, 9, and 10 be-long ? What other members of those orders do we meet with,and what do we employ in practice ?-Clinical Examination(Radcliffe Infirmary): Write a clinical report on the casesof , whom you will find in . State the

probable course of the oases, and write a brief commentary onthem. Are the specimens of urine marked A B respectivelyhealthy ? If not, state in what particulars they are abnormal.If unhealthy, what indications for treatment do they furnish ?Give an account of the microscopic appearances observed inthe specimen marked D.The examiners were Dr. Acland, Dr. J. W. Ogle, and Dr.

Rolleston.

)StT OF THE PRINCE AND PRINCESS OF WALESTO THE LONDON HOSPITAL.

THE visit of the Prince and Princess of Wales to the London

Hospital, on the occasion of laying the first stone of an addi-tional editice to be called the " Alexandra wing," is an event

the deepest interest, not only to the members of the medicalprofession, but to the English nation. At this time, whenwars and rumours of wars prevail-when the continent ofAmerica is deluged in blood, which the continent of Europethreatens to rival by scarcely less disastrous encounters-whenmen’s hearts fail them for fear, and the political horizon seemsovershadowed with the deepest gloom, the Heir Apparent ofthe English throne visits the poorest district of our greatmetropolis to inaugurate a temple raised by voluntary subscrip-tion for the relief of human suffering, and by his presence andexample seeks to encourage others to a similar interest inworks of benevolence and charity. The country is truly for-tunate whose future ruler gives such practical illustration of hisdisposition to co-operate with men of every class in those under-takings which have as their objects the relief of suffering and thesocial progress of the poor. Such as example as that whichthe Prince of Wales affords cannot be too highly estimated. It

speaks to foreign nations of the source of England’s content-ment and happiness : good rulers and a free people; royaltytaking the initiative in works of public usefulness, and a peoplerendering willing devotion to their Sovereign. Affection and

respect are stronger protectors of a throne than marshaled’battalions. The nation constitutes the guard of those whoseroyal virtues are treasures in the hearts of its people. The

Prince of Wales’s interest in our charitable institutions cannotfail to exercise a happy influence on the many titled andwealthy young men who throughout England have such ampleopportunities of doing good. They may learn some of the pri-vileges of their position, and feel that local claims and localcharities may not unworthily occupy their attention, whensimilar duties are so righteously attended to by him whom thenation delights to honour.The speech delivered by his Royal Highness at the sub-

sequent d&eacute;jeunel’, at which the Duke of Cambridge took thechair, was worthy of the occasion, and deserves to be tran-scribed as one of those happy efforts whose highest eulogy restsin its repetition :-

" Your Royal Highness, my lords, ladies, and gentlemen, itwould indeed be unbecoming in me if, after the kind and flat-tering manner in which you have drunk to the health of thePrincess and myself, I did not rise to express our sincerethanks, and to assure you of the gratification we both feel inbeing present. We entertain a deep interest in all the insti.tutions of the country ; in none more than those institutionsdevoted to charity ; and, I will add, in no specially charitableinstitution more than this very one. I speak from experiencewhen I declare my belief that its importance in this neighbour-hood, and its claims to general sympathy, are very great. Ihave walked through some of the wards-(cheers)-and haveseen how well the patients are tended and cared for. Andyet, much as this additional wing is needed, and greatly as itwill extend the benefits of the institution, you must pardonme the hope-which arises from the sorrowful sights I havewitnessed-that it may never be quite full. (Loud cheers.) Iwill not detain you longer; but, once more thanking you foryour kindness, I beg to propose the toast, Prosperity to theLondon Hospital.’ "

It is scarcely necessary to add that the utmost enthusiasmwas manifested for the success of the institution. The largesum of .67,000 was subscribed for the endowment of the ward,a fact which affords a startling contrast to the expenditure nowexhausting the revenue of other states, when the destructionof human life, not the alleviation of human suffering, is ther<;1l1 t.

THE RECENT EPIDEMIC OF SMALL-POX INTHE METROPOLIS.

THE Report of the Medical Officers of the Small-pox andVaccination Hospital (included in the Annual Report of theHospital), enables us for the first time clearly to apprehendthe gravity of the recent epidemic visitation of small-pox inthe metropolis-a visitation which indeed has not yet fullyterminated. It was already known that the epidemic wasthe most formidable one in extent from which London hadsuffered for many years. We now learn that the disease was

unusually severe and fatal. The epidemic commenced in

November, 1862. In 1863 no less than 1537 patients (15 ofwhom were not suffering from small-pox) were admitted intothe Small-pox Hospital, and 102 beds were found quite inade-quate to meet the claims made upon the institution. Severalof the larger London parishes were under the necessity of pro-viding special accommodation for their own pauper patients.The largest number of patients were received into the hospitalin June and July. The deaths during 1863 amounted to 274,or 17 per cent. of the whole admissions. One of the cases ad-mitted occurred after a previous attack of small-pox, and oneafter small-pox and vaccination. Of the remaining 1520 cases,247 were unvaccinated, and 1273-no less than 83 per cent. ofthe admissions-vaccinated. The deaths amongst the unvac-cinated averaged 47 per cent.; amongst the vaccinated, 9 -9 percent. The mean death-rate, over a series of years, amongstthe unvaccinated has been 35 per cent.; and amongst the vac-cinated 6 per cent.These results furnish a guage of the severity of the epi-

demic, and at the same time conclusively show the necessitywhich exists for an amendment of the vaccination laws. Itis a great public scandal that so large a proportion of the pa-

48

tients received into the Small-pox Hospital in 1863 should havebeen vaccinated. While these cases manifest in the most markedmanner the influence which even an imperfect vaccination ex-ercises in modifying and diminishing the fatality of small-pox,they also clearly indicate the shameful carelessness with whichmuch of the vaccination in vogue has been performed.

THE BREATHING-PLACES OF THE METROPOLIS.

OTHER arguments than those which have been urged by Mr.Doulton might be advanced to show the necessity of preservingthe waste places in and about the metropolis. It should be asufficient reason that, even with its present population, Londonis altogether too scantily provided with breathing-places. It

is well, however, to have some regard to remote contingenciesas well as immediate needs. The Registrar-General, in com-menting on the results of the last Census, justly states, thatwhether London is equal to the task of providing by newand improved arrangements for the constant accumulation ofits population, remains to be determined by experience." When a family," he says, "increases in its narrow lodging,in circumstances of dirt and squalor, that increase which shouldbe its blessing becomes its bane. And in a city or state thegrowth of its population is not a strength to be trusted, but aweakness to be feared, if improvement in its physical andmoral condition is not commensurate with the growing urgencyof its wants." London is the least unhealthy of greatEuropean cities, but it is not on that account healthy. One-third of the lives lost within its bounds yearly are wasted.They constitute the life-tax we pay for the neglect and in-difference of preceding generations. It is not sufficient thatthe sanitary dykes we have built, and are building, are tosome extent checking the death flow. Their stability is as yettoo little assured for us to rest full confidence in them, unlessincessantly watched and continually strengthened. The rate ofmortality, after declining several years, is beginning to stealup, and if heed be not taken the ground which has been gainedmay be lost. The vast and continued augmentation of thepopulation daily increases the diffi,:ulties of successfully con-tending with the death-flow. It is impossible to dissociate,however difficult to establish the precise relation between, theenormous development and persistent fatality of scarlet fever,the " plague" of the present day in this country, from thecolossal growth of the population and its close massing to-gether. The evils to be dreaded from this source, unless

anticipated, will never be satisfactorily met. It is an incentiveto the exercise of foresight that the present generation willgain by it as well as the future. But the common requirementsof morality forbid us leaving to our children such terrible lega-cies of noxiousness as now tax so formidably our health andour pockets. The members of the Government which secures

breathing-places for the future outgrowths of the populationmay be envied the pleasant fame which awaits them in thehistory of the people.

VENTILATION OF SHIPS.

AT length the attention of the authorities seems to have beendirected to the absolute necessity of giving proper ventilationto our ships of war. We have long advocated this necessity. Dr.Gavin Milroy, one of our ablest and most persevering sanitaryreformers, has on this subject repeatedly placed his opinions onrecord in the pages of this journal. We have much pleasurein transcribing the following leading article from the F?6KHp-shil’e TeZegraph :-

" During the experimental trial of the Royal Sovereign onThursday, much interest was shown by tha distinguished navalofficers and other scientific gentlemen on board in the generalventilation of the ship, and the Admiralty authorities andCaptain Coles deserve much credit for their laudable endeavoursto make the ship as perfect in this respect as the exigencies ofsuch a peculiar structure would admit of. On the whole the

result is successful, although, probably from want of an originalcomprehensive plan, some defects are observable. One newfeature, however, which elicited marked approbation was theventilation of the ship’s frame and timber spaces, and conse-quently of the bilges, by a plan invented by Dr. Edmonds, ofthe Vict017f, and by which all these timber spaces are, by asimple process, converted into ventilators, instead of, as

hitherto, acting as vitiators, and the effluvia from which-too-well known by naval men-have long been known as fertilesources of disease and discomfort to all serving in the tropics,where, intensified by a high temperature, they created, or atleast fomented, the fatal fevers which have so often ravagedsuch ships as the Ecla&Iacute;1’, Tmeed, Highfl!Je1’, and a multitude ofothers. It is clear that we have in this new system a means.not only of preventing the action of such detrimental causes,but also of absolutely removing them, by acting on their sources,which are identified with the causes of dry rot in ships, whichmay be equally prevented. In steamers in which this systemis adopted the funnel is the great ventilator, and it was foundon the occasion of the Royal Sovereign’s experimental trial,steam being up, that the enormous volume of 225,000 cubicfeet of the foulest air of the ship was constantly being carriedof by the air trunks at the rate of thirty-one feet per second.On the day previous, by the passive action of the funneldraught alone-no fires being lighted-one third of thisquantity was being carried off, and when this stream of foulair was intentionally diverted from its upward course for a.

moment into the space between decks its odour was veryindicative of its source, It is well known that previous to theconversion of the Royal Sovereign into a turret. ship, whilst shewas a three-decker, her bilges were always very foul, and byno care could this evil be removed. Now, with the presentsystem, if the most ordinary precautions be taken the ship canbe kept perfectly free from accumulations of foul atmosphere,and there can be no doubt that this invention, if generallyadopted, will materially improve the hygienic condition of thenavy." ‘’

Let the reader mark what was the state of the atmosphere inthe between-decks (where the men are berthed and usually socrowded together at night) whenever the ontflowing stream ofimpure air from below was interrupted, and then he may judgewhat its effects must be on the health of the crew, especially inhot climates and in epidemic seasons. Again, why should thebilges of the -Royal Sovereign have been permitted to con-tinue always offensive before her change ? Does not this fact

serve, amongst a host of other examples, to show the urgentnecessity there is of a thorough inquiry being instituted by theAdmiralty into the sanitary condition and arrangement of ourships of war generally ? "’

COLLEGE OF SURGEONS: ELECTION OFCOLTNCILLORS.

THE annual election of Fellows into the Council of this insti-tution took place on Thursday, the meeting being held in thenoble library of the College; and at no time since the charterwas granted to the College, empowering the Fellows to electfrom among their own body representatives for seats in theCouncil, has there been so much interest excited, not even lastyear, when a junior Fellow displaced the Serjeant Surgeon toher Majesty (Mr. Caesar Hawkins), who had also twice filledthe President’s chair. At two o’clock precisely the PresidentMr. F. C. Skey, accompanied by the Vice-presidents, Messrs.Hodgson and Wormald, entered the library, when the Presi-dent explained the object of the meeting, and the gratificationexperienced by himself and colleagues in witnessing the greatand increasing interest taken in these elections as evidencedby the large and distinguished body of metropolitan and pro-vincial Fellows then assembled. He also alluded in eloquentterms to the great loss sustained by the Council, the profession,and the public at large, in the death of Mr. J. H. Green, thePresident of the General Council of Medical Education. Inconclusion, the Fellows were invited to deposit their balloting..papers in a large box provided for the purpose ; and it waa

r not until half-past four that this process had been gone through;

49

when scrutineers having been appointed, and the result handed Ito the chairman, he declared the choice of the Fellows to havefallen on Messrs. Le Gros Clark, Hancock, and Curling.The following is an analysis of the votes given on this

occasion :- I

The votes recorded for each candidate were therefore asfollows :-

REPORT OF THE COMMITTEE ONCHLOROFORM.

THE report of the Committee of the Medico ChirurgicalSociety on Chloroform has been produced this week, and anabstract of it was read at a special meeting of the Society heldon Tuesday last. The labours of the Committee have been

very protracted; upwards of seventy meetings having beenheld, and a very large number of experiments performed. Thereport is of so great length that we shall find it difficult evento present it in abstract, since it will involve so considerable ademand on our space. We shall, however, endeavour in ournext impression to print a satisfactory abr&eacute;g&eacute; of the more im-portant parts of the document. Meantime we may mentioneome of the leading facts.The Committee have especially investigated the important

question of the influence of chloroform on the heart and onrespiration. Here are their most important conclusions on thispoint. They say that " the first effect of chloroform vapour is

to increase the force of the heart’s action, but this effect isslight and transient, for when complete anaesthesia, is producedthe heart in all cases acts with less than its natural force.The strongest doses of chloroform vapour, when admitted freelyinto the lungs, destroy animal life by arresting the action ofthe heart; whilst by moderate doses the heart’s action is muchweakened for some time before death ensues; respirationgenerally, but not invariably, ceasing before the action of theheart, death being due both to the failure of the heart’s actionand to that of the respiratory function. The danger attendingthe use of chloroform increases with the degree of stupor itinduces ; the apparent irregularities in the action of theanaesthetic mainly depending on the varying strength of thevapour employed, on the quality of the chloroform, and on theconstitution of the patient. In order that it may be adminis-tered with comparative safety it is necessary that the per-centage of vapour should not exceed three and a half per cent.,that its effects should be carefully watched, and the inhalationsuspended when the required anaesthesia is induced. In manyrespects the action of ether is similar to that of dilute chloro-form. At first its vapour increases the force of the heart’s

action, an effect which is both greater and of longer durationthan that observed with chloroform. The stimulation is fol-lowed by a depression of the force of the heart’s action, but,at the same degree of insensibility, ether does not depress theaction of the heart to the same extent as chloroform ; even-tually ether kills partly by enfeebling the action of the heart,but chiefly by arresting the movements of respiration. Thus theenergy with which chloroform acts and the extent to which it

depresses the force of the heart’s action, render it necessary toexercise great caution in its administration and suggest theexpediency of searching for other less objectionable anesthetics.Ether is slow and uncertain in its action, though it is capableof producing the requisite insensibility, and is less dangerous inits operation than chloroform. On the whole, however, theCommittee concur in the general opinion which in this countryhas led to the disuse of ether as an inconvenient anassthetic.A mixture of ether and chloroform is as effective as purechloroform, and a safer agent when deep and prolongedanaesthesia is to be induced ; though slow in its action, it issufficiently rapid in its operation to be convenient for generaluse. A mixture composed of ether three parts, chloroform twoparts, alcohol one part (by measure) is to be preferred onaccount of the uniform blending of the ether and chloroformwhen combined with alcohol, and the equable escape of theconstituents in vapour, and the Committee suggest that itshould be more extensively tried than it has hitherto been inthis country." As to resuscitation, they find that "the mostcertain means of restoring life after poisoning with anaestheticsis by artificial respiration. By this means resuscitation maygenerally be accomplished after natural respiration has ceased,provided the heart continue to act ; and it may sometimesbe effected even after the cessation of the heart’s action, butthis result is exceptional. Galvanism resuscitates within thesame limits as artificial respiration; it is, however, far less to berelied on than artificial respiration in equal cases. With either

remedy it is found that animals quickly rendered insensible bya strong dose are more easily recovered than those which havebeen gradually narcotized even by a small per-centage of theanaesthetic." "

In their rules for the administration of chloroform, they statethat an apparatus is not essential to safety if due care be takenin giving the chloroform. Free admission of air with theanxsthetic is the one thing necessary, and, guaranteeing this,any apparatus may be used. Three and a half per cent. is the

average amount, and four and a half the maximum proportion,of chloroform to atmospheric air which is either needful orsafe. In case of accident in the more threatening conditions,artificial respiration is advised to be commenced instantly, andthis equally in all cases, whether the respiration has failed