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plied as circumstances would permit, and thelower bowel was solicited to act by meansof enemas.The observation of Sir Astley Cooper is

completely verified in this case; namely," that the degree of danger attending an ar-tificial anus, depends on the vicinity of thesphacelated part of the intestinal canal to thestomach. Thus, if the opening be in the

jejunum, there is such a small extent of sur-face for absorption between it and the sto-

mach, that the patient dies of inanition."Now, although my patient is capable ofwalking about the ward, she is still veryweak; the food she takes affords her verylittle nourishment, and she is tormented withconstant colicky or griping pains in thebowels; a condition that is most likely tooccur from the cause above alluded to, as itwill be seen, on referring to the case, that, ontaking the slightest portion of food, faecesand wind would pass out of the opening, or onthe slightest motion of the body.

In the case of the lady alluded to, I ad-vised the application of a light double truss,which afforded great support and comfort,and allowed her to walk with safety. From

finding that she complained of great weaknessof the side, and a tendency to hernia on theopposite side, I have suggested the use of atruss in this case, of which the medical gen- itleman under whose care she is at present i

approves. From the same reason it will befound useful to apply a double truss in thecases of single congenital hernia of children,although it may appear paradoxical ; stillthe support is equal, and the cure is renderedmore comnlete.

It is not for me to aggravate the facts in acase of this kind, which carries with it, inevery particular, the condemnation of the in-dividual (and an everlasting opprobrium onour laws, which permit such a state of thingsto continue), who, with his little knowledge,could take upon himself its treatment. Theadvice he gave the patient, to keen 41 herhead low and her legs high, and knead it up,"proves that he was aware that it was a caseof hernia. Had this woman died, his situa-tion would have been most precarious.

Stonehouse, Dec. 23, 1841.

MEDICAL EDUCATION.

APPLICATION OF THE COLLEGIATE SYSTEM TO

THE MEDICAL SCHOOLS OF LONDON.

IM the month of August we called theattention of our readers to a pamphlet onthe above subject, written by the Rev. J. H.North, the chaplain to St. George’s Hospital,and we then expressed our favourable opi-nion of his views, and our fervent hope thathis pamphlet might arouse the attention ofthe profession to this important matter. In

the " British and Foreign Medical Review"for the present month, we have the satisfac-tion of seeing the subject taken up in an ani-mated manner, and the advantages of thesystem very ably demonstrated. From thisarticle we make the following extracts,which we think deserving of the most seriousreflection of our professional brethren :-Amid the loud and justifiable cries for me-

dical reform with which the whole’kingdomat present rings, it is both wholesome anddesirable to receive the faithful warnings ofa friend who calls upon us to look at homeand to rectify evils which lie at our own door,and concern us, as a profession, still morenearly. Into this category, unquestionably,must come those evils-great and manifold-which spring from the total deficiency of anysystem of collegiate discipline in our medicalschools. The reform of these depends en-tirely, or for the most part, upon the consci-entious sense of duty in the members of theprofession itself; they demand no Parliamen-tary interference ; their removal will infringethe rights of no corporate bodies; whileevery step that shall be taken towards theircorrection will be in itself a positive good, ablessing conferred upon the rising membersof the profession, and through them on thecountry at large.

After premising the forlorn and helplessstate of the student on his first arrival in

London, the reviewer observes zSuch being the state of the medical pupil,

-or at least of the majority,-during his re-sidence in London, " a sheep having noshepherd," can it be wondered at that hisgood intentions speedily give way to the se-ductive allurements of vicious companions ?His moral and religious principles are in-jured, perhaps destroyed. Cards, billiards,and every sort of vicious incentive lead himon; his studies are neglected; his time, tooshort even under the best system of economy,is wasted, and he at last contents himselfwith the disgraceful alternative of cramminghis memory, under the guidance of a grinder,just up to that point which may cheat thevigilance of the examiners. And thus heleaves the hospitals to engage in practice,but very little wiser than he entered them,having completely wasted the most valuableyears of his educational life entirely fromhaving begun badly, from never having hada fair start in his course.On this point we cannot forbear giving the

words of a man of no mean authority, Dr.Pusey, as quoted in an excellent article inthe " Quarterly Review" for January, 1840.Speaking of the German universities, Dr.Pusey says,-" On the removal of the stu-dent to the university he passes Rt once fromboyhood to manhood ; at once, instead ofdiscipline and control, he is left almost un-fettered even by moral guidance; the only

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requisition made is, that he should attend course with them in the school, which isone or more sets of lectures. Some general necessarily of a very limited extent. Theadvice is also given him as to the method only exception to this general rule is to bewhich it may be most advantageous for him found in King’s College. The late excellentto pursue; but beyond this, what instruc- principal, Mr. Hose, had much at heart thetion he should receive, and from whom, introduction of collegiate discipline in thatwhether he should live as a Christian or as a school, and his views have received encou-heathen (provided he interrupt not the public ragement and support from all the profes-peace), is left to his own option." In this sors, but hitherto their practical applicationdescription of the errors of the German has been very limited. Sufficient, however,schools we at once recognise those of our has been done to convince all who have ob-own ; and so correct is the likeness, that we served the influence of this arrangement, ofmight with slight alteration substitute the the great advantages to be derived from it,one for the other. But even granting that and nothing now seems wanting but thethe discipline in foreign schools is just what energetic efforts of the friends of that insti-it should be, the condition and the require- tution to carry out the desired plan withments of a London university must widely complete effect. All the other colleges anddiffer on this point from any or all of them. schools have confessedly made no attempt toThe vast size of our metropolis has, we secure any further influence over the studentsdoubt not, a very prejudicial effect upon the than what may be effected by the generalmoral habits of a class of young men thrown system of annual rewards for the most indus-together without any feeling of responsibility trious, and the very occasional correction ofor control. Indeed, we cannot but consider the most idle by the withholding of their cer-that this fact alone, in the present state of tificates of attendance upon lectures.things, constitutes a very decided and im- It is unnecessary to enter into any detailsportant objection to. the metropolis as the respecting collegiate arrangements so wellsite of medical schools; and we rejoice, on known as those of our ancient universities.this ground, at the recent establishment of We shall pass in review their more charac-so many excellent medical schools in the teristic features, and consider the adaptationprovinces. And though the eminence of the of a modified system of the same generalmetropolitan professors, and the numerous kind to the wants of the London schools.

advantages possessed by the London schools, 1. College Rooms.—We are quite awarewill always attract the greater part of those that there are objections to the crowdingentering the profession, yet we must look together a number of young men, and thatupon an education in the country as having the fears of some sincere friends tp the intro-at least superior advantage, in a moral point duction of a better system than the presentof view, and as thus possessing the power to are strong upon this head. We confess,abate, in some degree, the evil which we now however, that, knowing as we do, the difli-hope to see abated in London, culties which require to be overcome in the

Let us now examine somewhat more in introduction of a new system-and that onedetail the system which is at present adopted which must, to a certain degree, curtail theby students in London, and inquire what are liberty of young men-we still are so certainthe facilities for the introduction of a com- of the advantages which must arise from aplete plan of collegiate discipline. We fear judicious and cautious administration of thethat unvarnished truth must declare, that discipline, that we ourselves have no fearsfrom beginning to end, whether with regard whatever as to its ultimate success. Thereto moral discipline or professional study, is one principle, however, in connection withsystem there is none. The only guide as to this part of the question, which must, atthe course which the student is to take is his least at first, be admitted, to meet the preju-own inexperienced judgment, assisted by dices and the jealousy of control, natural atthe curriculum of required attendance upon the age of medical students. We shouldlectures from the Apothecaries’ Hall and the recommend, that for the present the submis-College of Surgeons; books he is to select sion to the restraints of college life should beat his own discretion, and the disposal of his made optioital with the student. The advan-time is under the same direction. On first tages which are certain to flow from it mustcoming to the London hospitals, one of two be the inducement to him to submit to its

plans is generally adopted; either he is restraints, and if for any reason he prefersplaced in the family of some surgeon or phy- being left entirely at liberty, let him havesician in the neighbourhood of the school his will. By this means one great advan-that he is attending, or, which is much the tage will result to those within the college,most frequent plan, he takes a lodging in the that the dissipated and ill-disposed will be

vicinity, generally in the same house with separated from them, and thus a great hin-two or three other students. In this last drance to their studies and good conduct willcase, of course, the time rmd conduct of these be removed. There are also many obviousgentlemen is under no control whatever, with and sufficient reasons which would inducethe exception of whatever influence the par- some of even the best disposed to preferticular professors mayaave in their inter- living at a distance from the hospital; as, for

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instance, in the case of the residence of the i

pupil in the house of his parents, or their re-lations, or friends.

In reference to the possibility of providingaccommodation for all that may require it,we request attention to the following con-siderations. The average cost to the medical

pupil of his lodging at present is about 14s.per week, which, granting that he stays onlyeight months in the year, makes 241. Forthis sum he is often content to obtain a smallbed-room and sitting-room, in a confined

gloomy situation. Now, if we fix the ave-rage terms to be demanded by the college at

20., one hundred resident students wouldproduce an income of 20001. Out of thisdeduct 5001. for incidental current expenses,such as servants’wages, repairs, &c. &c., andwe have still 15001. as the return for the capitalinvested in the building. This sum, calcu-lated at 5 per cent., would be the equivalentof &bgr;O,OOOl. principal, a sum, we conceive,more than sufficient for the required purpose.But it is to be borne in mind, that this calcu-lation is made at a high rate of interest, cer-tainly higher than money might be raised for;not to mention all abatement on the score of

donations, which would certainly be receivedtowards so good a cause. We have alsohere provided only for one hundred students,but few of the large schools would have sosmall a number accommodated within theirwalls, and some would have many more :moreover, the larger the building the less

proportionally will be the expense ; that is,room for two hundred pupils would not costthe double of what would be required forone hundred. The average rate of charge tothe student might, as we have said, be 20L ; ;but, of course, this must vary in each caseaccording as he chose to have one or tworooms, or according to the floor on whichhe lived, as in the chambers at the inns ofeniii-t-

If a college residence be thus provided forthe students, it is obvious that a system ofregular discipline in regard to hours of ad-mission at the gates must be adopted to givethe whole system that efficient power of con-trol which is essential to the proper govern-ing and guiding of a body of young men. Wedo not, however, say more upon a part of thesubject on which we may be opposed to theviews of many well-wishers to the collegiatesystem, because we now only desire to makea general sketch of our proposed plan. Thedetails may be further discussed hereafter.We now only desire to give an impulse to thepublic feeling already excited.Though it will be highly desirable that all

students who are willing should be receivedwithin the walls of the building, yet undersome circumstances of want of accommoda-tion, licensed lodging-houses might be per-mitted, under the same rules and disciplineas in the college itself ; but of course allfreshmen, and as many as possible of the

senior students, should be required to livewithin the walls.

2. TMors.—The establishment of residentcollege tutors is the most important part ofall the system under discussion. This is all

improvement that is imperatively demanded,and which is so reasonable, and so easilyaccomplished, that if nothing else is donethis must. At Cambridge and Oxford,(where, by-the-by, the college tutor is by nomeans what he might be and ought to be,)this functionary is appointed from among thefellows, and receives from each pupil allottedto him from 2l. 1 Os. to 4l. per quarter; orfrom 101. to 161. a-year. If twenty-five stu-dents are appointed to be under his tuition,this will realise to him an income of 250l. to4001. At the universities the tutors havealso their fellowships, and these, togetherwith the pupils’ fees, produce a handsomeincome. This, however, is not to be expected,or indeed desired, in London. Let a tutorbe appointed to every twentv-five students.who shall pay him each 8L or 10!. a-year :this will give him an income of 2001. or 2501. ;and of course his rooms will be found for him,and perhaps his board. These tutors mightbe chosen by examination from the mostmeritorious of the third years’ pupils; andthough some preference should be shown tothe members of the particular school, weshould advise that the election should not berestricted to them, but thrown open to all theschools. How many men of superior talentsand attainments would be delighted to obtainan appointment, which would enable them topursue their studies with comfort for severalyears longer than they might otherwise beable to do ! The duties of the tutor shouldbe much the same as they are at the univer-sities. He would be the friend and guide ofthe pupil; his mentor in every respect. Hewould superintend and assist his studies,practical and theoretical, and second the in-structions of the professors by frequent cate-chetical exercises. His superintendenceshould not be permitted to extend to morethan the number we have mentioned, lest itsefficiency might be proportionately dimi-nished. By means of this system of tutelage,the student would be saved from vast wasteof time and labour, and at a less expensethan he now pays for a three-months’ assist-ance from the gTinde1’, that dernier resort ofidleness. This disgraceful system of pre-tended instruction we should hope to see

entirely superseded by the proposed reform.If it should be thought unadvisable that thetutors should be chosen out of the class ofstudents, and that the office would requiremen of longer standing to lieep up due au-thority, we have no doubt that such an officewould produce numerous candidates. Thereare many most competent persons who wouldprefer such a life to the anxieties of privatepractice. Perhaps a beneficial arrangementmight be-for the tutors of the first-year’s-

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men to be chosen according to the first plan ;and the two-years’-men might have thesesenior tutors.We feel confident, from a considerable

experience among hospital pupils, that a planof instruction, such as might be carried onsomewhat according to the above sugges-tions, would so exactly accord with thewants and wishes of this class of young men,that this alone would be a sufficient induce- iment to them to submit to the partial re-’ istraints necessary in a college life. Addi-tional inducements might be found in privi-leges, rewards, and appointments, to becompeted for only by those within the rules.

3. Domestic Arrangements.-There shouldbe one or two dining halls in the college.When the numbers are large, we should pre-fer two. The students might be classed asfirst and second-years’ men, and occupydifferent pa.rts of the building accordingly,and use different dining halls: the tutorsalwavs dining: with their classes.

4. Religious Observances.-Prayers shouldbe read at the chapel of the college night andmorning, and encouragement given to theregular attendance on them at least once onevery day, and not less than once on Sunday.How far it might be desirable to adopt thesystem of fines for non-attendance, we have estrong doubts ; and we have not space, nor isit at present necessary, to discuss the point.Of this, however, we are certain, that theregular attendance upon the ordinances ofreligion as a means of moral control, as wellas of religious instruction, is of the greatestimportance to the younger members of ourprofession, who in the exercise of that pro-fession are about to enter upon duties of

great moral responsibility and difficulty, andwho therefore peculiarly require the guidinginfluences of a religious and moral education.

5. Costume. - A Darticular academicaldress is a matter of much less importance inLondon than in Oxford and Cambridge ; andwe have even doubts of its utility : it cer-tainly is not necessary.

6. Rewards and Penalties.-It may be ob-jected that a system of collegiate disciplinemust be incomplete without the adoption ofrewards and penalties for the enforcement ofthe authority of the college, and that therewill be serious difficulties opposed to theexercising of such authority, unless all themetropolitan schools come in to the sameplan. We answer that to a judicious andcautious application of such control therewill be no difficulty on the part of the stu-dent, for whose benefit it is to be adopted,who will cheerfully submit to a necessarycontrol for the sake of the immense benefitsto be palpably derived from the whole sys-tem. Neither need the individual schoolwhich shall boldly put itself forward to

remedy the present evils fear to stand alone,since the object in view is confessedly so im-portant, that there can be no doubt that the

existing examining bodies must and willgladly assist the undertaking by their sanc-tion and support, and by granting a properdegree of consideration and weight at theirexaminations to the certificates of good con-duct accorded by the individual college. Itwill obviously be to the interest of the schoolto temper and soften the necessary strictnessof its rules, and to, encourage submission tothem by rewarding good conduct.On reviewing the brief and imperfect sur-

vey which we have made, both of the evil andthe remedy, we feel confident that we haveoverstated neither the magnitude of the one,nor the feasibility of the other. Deeply im-pressed as we are with the malignancy of thedisease, we are satisfied that, if by any hintof ours we may have contributed towards thesuccessful application of the remedy, weshall have rendered a high and most impor-tant service to our profession and, throughits members, to the public. We rejoice,indeed, to see that the community at largeare at length becoming sensible of the impor-tant and inseparable connection between itsinterests and ours. The moral as well as theintellectual character of our profession mustnecessarily have a most important bearingupon the welfare and happiness of society ingeneral. On every account, therefore, wehope most earnestly that the governors of themetropolitan hospitals, and the lay patronsand supporters of our schools, will feel thatit is their bounden duty-assuredly it is theirinterest-now to use their best efforts, in

conjunction with their professors and medi-cal officers, to organise an efficient system ofcollegiate discipline for the benefit of theirpupils. Indeed, according to our own opi-nion, the subject rightly viewed can leave nooption to those who have the managementand control of our medical institutions. Theyare bound by all the sanctions of moralityand of religion no longer to allow a largebody of our youth to lie exposed to the un-controlled temptations of a vicious metropo-lis. Of the success of the proposed plan, ifonce set on foot, we are so confident, that weventure to. prophesy that if only one of ourschools sets the example, the rest must, inself-defence, follow ; and nothing would gra-tify us more sincerely than to witness thecommencement of this honourable rivalry sopregnant with advantage to our profession.

MIDDLESEX HOSPITAL.

INJURIES OF THE EYE. CLINICAL REMARKS BY

MR. ARNOTT.

CASE I.-Rupture of the Globe by a Blow,Loss and Recotery of Sight.-John Hays,aged 39, was admitted October 4, ] 841,under the care of Mr. Arnott. This man,who has but one eye, the left having been de-stroyed by an attack of severe inflammation,