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medical skill As it was observed, " Everybody knows a patientmay often be saved by careful nursing when everything elsewill fail." At no place was this more distinctly proved thanin the military hospitals playing so prominent a part in themedical history of the Crimean campaign. "Nurses must be

improved," asserted every active member both of the generaland medical committees of every hospital, in response to thedemands of that great-hearted lady who has brought about somany sanitary reforms. Any inferiority or arrest of improve-ment, showed Miss NIGHTINGALE, that is permitted in thenursing staff of an hospital is not only wrong in itself, but is inthe end far more costly, both to the funds and to the generalbenefits of an hospital, than better skill and training ever canbe. To combine the best medical skill with the best systemof nursing must be the primary object in every such place; forthus and thus only can the most efficient kind and the greatestamount of relief be ensured to the sick in the shortest possibletime. Instead of regarding a nurse as a very secondary medical

aid, and as one the production and multiplication of which inthe sick market were to be conducted on loose and mercenary

principles, the greatest care, it was averred, should be taken I

to properly educate the two sides of that character in whichshe was so prominently to appear. A nurse, it was to be re-

membered, had to show herself in two lights: first, as one

technically brought up to aid the sick in certain medical rela-

tions ; and, secondly, as one having to discharge this duty in away not merely perfunctory and without any feeling, but withall that tenderness towards and sympathy for the patientwhich would show that her duties were performed, not withindifference, but with actual kindness. Two things, then, hadto be regarded in the production of our future medical aids :on the one hand, to train and educate the woman technicallyto her office as to a handicraft; and, on the other hand, toraise her social and moral character. By the former, she wouldbe taught what she had to do; by the latter, in what mannershe should seek to do it.

Our readers are fully aware that great endeavours have beenmade in certain quarters to carry out the improvements hereindicated. The results of these-and which are augmentingin operation-are daily to be witnessed in some of our publiccharities. These are subjects of much talk and notoriety; andno rising institution, nor old one seeking to reform itself,should fail to observe narrowly the new systems of nursinghere and there introduced.

We are glad to find that so well-known and reputable anestablishment as the Norfolk and Norwich Hospital, upon theoccasion of its recent enlargement and remodeling, passed the

following resolution-viz., "That a committee of three or moreof the governors be appointed by the Board of Management tovisit six of the London hospitals, and to report at the nextGeneral Board all information they can obtain respecting the

system of nursing carried on in such hospitals." Before pro-

ceeding to visit the hospitals, the committee drew up a papercontaining twenty-eight questions, which they sent to the pro-per authorities at each establishment. Thus, much valuableinformation was obtained and much time saved during their

stay in London. The Report* of the Norwich commission isbefore us, and as the matter it deals with is second to none

* Report of the System of Nursing in Six of the London Hospitals, read atthe Annnal Meeting- of the Governors of the Norfolk and Norwich Hospital,April, 1864. Xorwich: Pig-g.

in interest both to the public and the profession, we shall returnto the subject of hospital nursing and the Report in questionat an early opportunity.

Medical Annotations." Ne quid nimis."

ECHOES FROM INDIA.

NOTHING can exceed the disappointment which the newIndian Medical Warrant has caused on its promulgation. After

waiting six years under doubt and suspense, deprived of theadvantages of the British Medical Warrant of 1858, and fedby many fair promises, the officers of that service are now

plunged into the bitterest depths of depression by this blowto all their reasonable anticipations of justice and of liberality.The press of India sympathizes heartily with the medicalservice; and although the public generally do not commonlyenter warmly into the grievances and hardships of a profes-sional department, on this occasion all agree to lament the in-justice, and to concur in the complaints. The long and excel-lent letter which we published last week from an IndianMedical Officer pointed out very clearly and in very temperatelanguage the deceitful character of this Warrant, which, whilegiving with one hand what could no longer be denied-payaccording to relative rank in India as in England,-takes awaywith the other more than an equivalent by cutting off the

staff allowance, which always has been made, and is the privilege, not only of the medical, but of every other branch of thepublic service in India, for the discharge of additional dutiesinvolving anxiety, responsibility, and labour.Our correspondence by this mail discloses the universal dis-

content which has been caused. The letters are from every rankin the service, from professors in the colleges down to assistant-surgeons in the Queen’s army, who are supposed to be the per-sons whom the delusive bait in the first part of the Warrant isintended to attract. They speak but one language-that ofdeep disappointment, weariness, indignation, and disgust. Wecannot print them all, but extracts from some of them willbe found in another column; and as indicative of the generalfeeling of dissatisfaction with which the Warrant has been re-ceived, we think it well to give here extracts from some of theleaders exposing the injustice of that document with which wefind the Indian press to teem. These will at least add force toour own opinions, will show students what those on the spotthink, and prove to the authorities that in urging them tobehave with more liberality to the service we are advocating acourse which commends itself to all but themselves, and whichthey are ignoring at the risk of ruining the department.The Delhi Gazette says :" The new medical scheme is nothing more nor less than a

, bait to tempt young men to enter the medical branch of thearmy ; and Sir Charles Wood’s promise, that a final decisionconnected with the future provision of the medical officers inIndia will be communicated hereafter must be valued at the

. same rate as all his other promises; and we would urge upon,

young graduates, who may be tempted to enter the medicaldepartment of the army, to pause before they take the fatal step.

. They will do well to remember that everyone looks forwardto enjoying in his old age rest and a competency ; but shouldthey expect that this will be their fate, judging from affairs as

- they at present stand, they will, without doubt, be sorely dis-appointed. Let no one jump into a deep and running streamunless he can swim, for of a certainty he will be drowned ; let

r no medical graduate be ’ foolhardy’ enough to venture his life9 and talents in a country like India, unless he has a better

assurance than the present of being able to lay up for himself’ a provision for his after-years : he must look to his chances oft promotion, noting well that no hopes whatever are held out to

him of holding the appointments of deputy inspector-general,’

and inspector-general, which have hitherto been the well-

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earned rewards of men who have spent the best part of theirlife in India. We infer from the absence of all mention of

superior grades in the present Warrant, that they are to beallowed to lapse, and if so, we will unhesitatingly assert thatthe treatment of the old medical officers is illiberal, and indirect opposition to the original guarantee of Parliament.Certain advantages of rank, pay, and promotion were promisedto the medical officers in India on their first joining the service,provided their duties were regularly and honestly performed.No one will say that those gentlemen have failed to carry outtheir part of the compact, but we can require no better proofthat Government has broken faith with them than the perusalof the unfair and unsatisfactory scheme now before us. Wecannot believe that the new medical Warrant was framed byIndian officers for the benefit of India, and trust it was not

plotted by the Horse Guards for the destruction of the Indianservice; though we know that it has been a sore thorn in theirside for some time past, and we have heard from very goodauthority that their name was used as a plea for not increasingthe pay of the Indian doctors, as it would compel them to im-prove the pay of their own, and ensure their keeping up theirdepartment in complete working order."

This is a forcible and suggestive statement. It is perfectlywell known that the scheme, as originally framed, includedthe amalgamation of the two services, and a more liberal schemeof pay. But the Horse Guards’ influence prevailed in creatingdelays and difficulties, in objecting to increase of pay, in

sounding the alarm lest the Indian service should be made alittle more attractive than the Queen’s army, which theyhave contrived to make odious to medical officers, and a sortof refuge for the destitute. They succeeded in stopping theamalgamation for the time, and it seems that they have alsoprevailed in paring down the Indian Warrant, and so shapingit, that while it holds out a gift with the one hand it inflicts astab with the other. Other journals, which are not equally wellposted in the affairs of the department, arrive independentlyat similar conclusions. The Lahore Chlonicle "congratulatesauthorities on having, after a delay of five years, thoroughlycompleted the disgust of the members of the British and Indianmedical services at the treatment they have received at theirhands."The Times of India, in a very able article, estimates the

total loss under the new Warrant to superior medical officersin the Indian service at nearly 2500 rupees; whilst further re-trenchments from the pay of surgeons in charge of Britishregiments or brigades of artillery are made, ranging in eachcharge between 200 and 350 rupees. It is indeed lamentablethat Sir Charles Wood should have put forth a Warrant soprejudicial to the medical service. It is deplorable that everychange which has been made in the regulations of the Indianmedical service has lowered the pay and diminished the advan-

tages connected with it. The present measure deepens thedisgust which the six years’ delay had already inspired. Yetlet it be remembered that this is the Warrant which Sir Chas.Wood represented to the House of Commons as a ground fortheir placing the service absolutely at his dictation, whenpressing upon the House the Indian Medical Bill, which wenow more than ever congratulate ourselves on having exposedjust in time, and Mr. Hennessy and The Times for having forcedthat exposure upon the attention of Parliament, and procuredthe defeat of the Bill. With what is proved now to be a totalmisrepresentation of facts, Sir C. Wood assured the House thatthe forthcoming Warrant would remove the grievances of theservice, suffice to satisfy those who had grounds of complaint,and tempt fitting men into the service. If this was not

treachery, at least it showed a total ignorance of the fair claimsof his subordinates, and of the condition of the service which herules. That Warrant is unanimously condemned by civilians,medical officers, and military officers ; it has caused the deepestdiscontent throughout the service; it robs it of more than it

gives, and leaves it worse off than ever it was, and degradedby comparison with any other service in India. Heaven helpit if the Bill had passed, and Sir Charles Wood had been leftas uncontrolled dictator !

THE PATHOLOGY OF TETANUS.

IN the Address on Surgery by Professor Humphry which werecently published, that clear-headed and philosophic surgeonappreciates justly the great work which lies before students ofminute pathology-a branch of scientific investigation which isoften unduly depreciated hy " practical surgeons," but to whichwe must look for the progress of the science of surgery and

medicine, especially in such dire diseases as cancer, tetanus,and hydrophobia, which present still unsolved problems ofterrible importance to humanity. " It is only by a close ob-servation of the manifestations of disease that we can hope toobtain an insight into its real nature. In this work the micro-

scope is doing vast service, opening up new regions of observa-tion and thought, and teaching us more and more of the closeconnexion between pathology and physiology, a connexion firstfully recognised by Hunter."

.

In the valuable and important communication of Mr. Lock-hart Clarke--one of the first histologists in Europe-a com-mencement is made towards the unsealing of the mysteries oftetanus. Skilled in the most difficult microscopic researches,-those into the structure of the nervous system,-he has resolvedthe well-known naked-eye appearances into definite lesions ofthe structure of the cord, which he describes and depicts

. with characteristic accuracy. He closes his communication bya request to be supplied with the spinal cords and medullseoblongatæ of any patients who have died of tetanus, which

! should be forwarded to him quite fresh or prepared simply’ in the manner which he there indicates. These he will under-

; take the labour of duly examining. We hope that his medicalbrethren will not forget that this skilled and patient investi-gator is desirous of thus multiplying his means of research,

r and will forward to him, when opportunities arise, the speci-s mens for which he asks.

SALE OF POISONS BILL.

THE important Government department which Mr. Simondirects with admirable discretion and skill, and which, perhaps

} more than any other department, is quietly laying the basis of

3 reforms most essential to the welfare of the people, has directed-

that investigation into the deaths by poisoning arising from1 free-trade in the sale of poisons for which we have long asked.1 The conclusions at which Dr. Taylor has arrived are identical,

so far as they go, with what we have urged. He has collected

ample information. Further researches have only disclosedmore proof of the mischief accruing from the unrestricted saleof poisons by uneducated persons ; from the absence of precau-

-

tions in handling and retailing them; from the extreme lati-tude with which the law interprets the phrase, " culpable

t negligence;" and from the impunity with which acts of utterinattention and carelessness, causing death, have passed un-

r punished. In the recent case of Lingard v. Clay and Abrahamheavy damages were recovered from that firm, but the assistant

e whose carelessness was the cause of death escaped all punish-ment. There is reason to hope that some well-devised form

: of Sale of Poisons Bill will now be arranged, which would meet

" with general support. -

te

MEDICAL CONGRESSES.

;, THis is the season for medical congresses and gatherings of all,t sorts. Germany is famous for some of these pleasant professionals meetings. One is fixed for the present week at Heidelberg, ate which all the principal continental and foreign ophthalmologistsI, will gather. Another is announced to be held at Lyons on the,t 26th inst.t A Munich letter states that the annual meeting of the Asso-d ciation of the Dentists of Germany has just been held in thatp capital, Professor Heider, of Vienna, presiding. More than a’t hundred members were present. The prize proposed for the

best "Instructions for the Treatment of the Teeth and the

274

Mouth" was awarded to Dr. Suerson, of Berlin; and that forthe greatest improvement in the mechanical department of theprofession to M. Schrott, dentist, of Mulhouse, for his method ofobtaining an exact model of the mouth and perfect articulationof artificial teeth.The meetings of the British Association and the Social Science

Congress are about to take place here in England. The formerat Bath. The latter will be held in York, from Thursday, the22nd, to Thnrsday, the 9t.h of September. Sir Charles

IHastings will preside in the department of Public Health. :

THE REPORT OF THE MEDICAL OFFICER OFTHE PRIVY COUNCIL.

A SUMMARY of the contents of the Privy Council medicalofficer’s sixth annual report was given in our last impression.AVe now purpose to examine somewhat more in detail Mr.Simon’s personal report of the proceedings of the departmentof which he is the chief during the year 1863. These proceed-ings are grouped under three heads. The first head refersto the continued superintendence of public vaccination,including the arrangements by which the national supplyof vaccine lymph is maintained, and by which effect is

given to the Privy Council’s order as to the qualifications ofcontractors for public vaccination. The second head refersto the continuance of the systematic investigation, which forsome years past has been in progress, as to the distribution ofdisease among different sections of the community, and as tothe circumstances by which that distribution is regulated.The third head refers to miscellaneous proceedings, sometimeswith local inspection, but more commonly in the form of cor-respondence with local authorities, in relation to particularoutbreaks of disease, and as to the local administration of lawsconcerning the public health.

I. The proceedings in reference to the superintendence ofpublic vaccination included the inspection of 1143 vaccinationdistricts, in 194 different unions or parishes. The reports ofthe inspectors represent the present state of vaccination in theentire metropolis, in the counties of Lancashire, Cheshire, andYorkshire, and parts of Wales, Herefordshire, Cumberland,Gloucestershire, Somersetshire, and Devonshire. Mr. Simonhas on former occasions written so fully on the "unsatisfactoryworking" of our system of public vaccination, that he thinks itnecessary merely to refer (as he has " nothing but the samestory to tell") to the abundant further evidence derived fromthe recent inspections in condemnation of this system and ofits working. But while omitting to dwell upon evils whichhave been already exposed, he adverts, though briefly, to theresults which those evils are producing. " Small-pox," hesays, "instead of being virtually extirpated from amongst us, iscontinuing to be a considerably fatal disease. Small-pox, whichfor eight consecutive years in the Grand Duchy of Baden, andfor thirteen consecutive years in the city of Copenhagen, tookaway not one single life, killed last year in London 2000 per-sons. In other parts of England it has been and is constantlyproving largely fatal. And probably five-sixths of its victimsare children under ten years of age, who, at least since 1853,under the vaccination law of that year, ought to be effectivelyvaccinated before they are four months old; but of whom, ifthey had been thus vaccinated, probably not one would have died ’,ofsmall-pox." This disgraceful state of things does not, however,exist in all parts of the country. We learn from the importantreturn setting forth the comparative mortality of the differentregistration districts of England and Wales, recently, on themotion of Mr. Lowe, laid before Parliament, that there are 44of the 627 districts in which not a single child under five yearsof age died from small-pox during the ten years 1851-60. Butfor the remaining 5S3 districts the return " shows," to useMr. Simon’s words, " results which gradually rise into the evi-

dence of enormous neglect." In Shrewsbury the death-rate fromsmall-pox in the period referred to amounted to more than aninth part, in Northampton and Plymouth to about an eighthpart, and in Merthyr Tydfil to no less than a sixth part, ofwhat in healthy districts would be a normal death-rate fromall causes.As in 1862, so in 1863 special means were taken to ascertain

the efficiency of the lymph supplied by the National VaccineEstablishment. Dr. Seaton inspected all the stations whenceany public lymph supply is derived, and " gave an entirelysatisfactory report of the quality of the lymph which was inuse."

Mr. Simon directs attention to some information of consider-able interest obtained by Dr. Sanderson in the course of aninspection of the vaccination districts of Gloucestershire andSomersetshire, and which makes doubtful the commonly re-ceived opinion that natural, cow-pox is a very rare affectionamongst our herds in all parts of the kingdom at the present day.Dr. Sanderson was informed by local medical practitioners thatnatural cow-pox was common at the present time in the dairyfarms of the Bridgewater level and of the vale of Gloucester-that is, in the whole of the level country round BridgewaterBay, between the coast and the Mendip and Qwantock hills,and in the whole pastoral country which from Gloucester to

Thornbury lies between the Severn and the Cotswold hills,having Berkeley (Jenner’s birthplace) in its centre. Dr. San-derson says on this subject: " From statements made to me by

practitioners in these districts, it appears that cow-pox is

usually to be met with in the dairy farms in the months ofApril, May, and June. When a dairy is invaded, the diseasenot only infects the whole of the stock, but is very frequentlycommunicated to the milkers-invariably men ; on whom thevesicles are seen on those parts of the haud which are appliedto the teat in the act of milking, particularly on the graspingsurfaces of the thumb and index nnger. The inoculating of

lymph directly from the cow has been practised in several dis.tricts with success. All who have employed such lymph agree

in stating that after the first or second transmission the resultsobtained do not differ from those of ordinary vaccination, eitherin respect of the progress or character of the vesicle."

Nineteen of the stations which are sources of national lymphsupply are used as educational stations. In this latter respect,as in the former one, the report is thoroughly satisfactory.

, II. The systematic inquiries of the Privy Council into the, circumstances by which the distribution of disease in England,

is regulated have now extended over five years. Mr. Simon’s

’ Report of 185S, " On the Preventability of Certain Kinds ofPremature Death," has served as a programme to the inves-

, tigations. Starting from known local excesses of a particular, disease, diarrhcea and diphtheria formed the subjects of inquiryin 1859; phthisis and other diseases in 1860 and 1861; diseases

causing infantile mortality in 1862 ; while typhoid fever hasbeen submitted to investigation in all the years, but especiallyin 1860. In addition, the operation of certain known morbificinfluences has been examined: as for instance, ’in 1862, theeffects of working with arsenical green, and also with phos-

! phorus. During 163 further proceedings of both sorts werecarried out by the Medical Department of the Privy Council,

- and considerable additions have in consequence been made tothe stock of information which had been previously collected by

the department. Inquiries of a third sort were also instituted-namely, " as to the sufficiency with which the primary wants

, of the body are satisfied amongst the poorest classes of the popu-; lation." The investigations into the conditions of nourishment

of our lowest-fed populations have been very ably carried out, so far as they have been as yet conducted, by Dr. Edward

Smith. The results of these important investigations, Mr.; Simon points out, are not so much for any present separate

application, as for use, connectedly with other facts, in future

- sanitary judgments. But he draws attention to some portions