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THE IRISH MEDICAL DEGREE PRIORTO 1858.

To the Editors of THE LANCET.

SIRS,-In a book lately published by Mr. R. BrudenellCarter entitled "Doctors and Their Work," the followingstatement occurs (p. 8): " While such was the state of thingsin England (i.e., prior to the Medical Act of 1858) it had beenfrom time immemorial the custom of Scottish and Irish uni-versities to confer degrees in medicine after examinationswhich were mainly medical in their scope, and which couldnot be held to establish more than a modest amount of

acquirement in scholarship or general knowledge. In thesedivisions of the Kingdom, therefore, the degree and title of’Dr,,’ instead of being confined to the highest grade of theprofession, belonged of right to the great body of generalpractitioners and represented something essentially differentfrom that which they represented in England."As far as Ireland is concerned nothing could be more

remote from the truth. The University of Trinity College,which up to 1852 was the only university in Ireland, hasfrom time immemorial made a degree in arts an indispensablecondition of degrees in medicine, as well as in all otherfaculties, except music. Among the" Regulse UniversitatisDubliniensis" is this: "Ad Baccalaureatum in Medicinanemo admittatur qui prius Baccalaureatum in Artibus nonsusceperit." Not only so, but of all British universitiesTrinity College is (with the comparatively unimportantexception of Oxford) the only one all of whose graduatesin medicine are also of necessity graduates in arts. It istrue that at the time of which Mr. Carter speaks there weremany general practitioners and apothecaries in Dublinstyling themselves "Dr,," bnt they invariably had Scottishqualification!’. Mr. Carter has promised to correct the errorshould his book reach a second edition.

I am, S.rs, yours faithfully,T. K. ABBOTT,

Senior Fellow and Senior Proctor, TrinityCollege, Dublin.

OPIUM AND PNEUMONIA.To the Editors of THE LANCET.

SIRS,-I was much interested in your leader in a latenumber on the subject of "Opium and Pneumonia" becauseI have been convinced for the past 15 years that that

drug has a deal to answer for in the mortality fromthe disease. Let us consider what is the condition atthe moment of crisis of that grave disorder. The lungis occluded with a thick tenacious slime almost im-

possible to throw off. The right heart is battling to

get the blood through this occluded lung. And what isdone by giving opium or any of its derivatives ? ? The

tenacity and thickness of the slime is increased and at thesame time the heart’s power is enfeebled and bewildered, alsothat of the respiratory centre. Could any therapeuticpower be less well directed ? ? We enfeeble and shackle thecardiac and respiratory powers at the very time their utmoststrength is required and at the same time add to theobstructive power, the tenacity and dryness of the slime.Surely this is clear, but what is the excuse for such a mode oftreatment Oh, it dulls and stills pain and restlessness andthe patient "feels better." Better? Yes. Euthanasia Thenecessary pain and restlessness must not be dulled ; they arerequisite for recovery. Excessive pain may be relieved by othermeans-a few leeches, an ice-bag, &c., or even a minute hypo-dfrmic dose of morphia not sufficient to have a constitutionaleffect. Aconite, too, is a most dangerous drug in pneumonia,given to "lower the temperature." But, alas, it paralysesthe cardiac centre. Such drugs as digitalis and strychninemust also be given with great discretion, for though theymay increase the cardiac power it must be rememberedthat they also increase the muscular tone of the arteries andtherefore resistance to that power.Now it is universally admitted that pneumonia is due to

a microbe and its toxins. It appears to me that treatmentshould be directed to the destruction of that microbe and itseffects and that symptomatic treatment should be entirelysecondary. With that view I have now for many years pre-scribed salicylate of soda with liquor ammoniae acetatis andin suitable cases (threatened heart failure) spiritus ammoniæaromaticus. The salicylate not only helps to arrest the

rapid multiplication of microbes but it rapidly throws off

the toxic products through the kidneys. The acetate of-ammonia not only counteracts any cardiac depression(though I have never noticed any as especially due tothe salicylate) but also liquefies and loosens the thick"slime" in the lung and makes it the more easy to ex-pectorate it. If we cannot be sure we are giving the rightdrug let us stand aside. Nature alone will do better than we.Let us be sure we do not add the last straw to the burden inthe terrible crisis.

Influenced by these views I have in later years only usedthe drugs I have mentioned in this dire disorder and theresult has been that I have never lost a case. I have hadmost serious cases, one in delirium tremens where anothermedical authority thought there was no hope, but the patientrapidly got well. Within the last few months I have hadtwo cases of pleuro-pneumonia in aged people the resultsof which are striking. The one, aged 69 years, a veryhealthy life previously, declined to take the salicylate, as

he said it made him feel sick. He recovered from theimmediate attack but developed an empyema which, afterrepeated aspirations (the pneumococcus abundant in everyspecimen of the pus), killed him by developing complicationselsewhere (operation was declined). The other, aged 76.years, an equally severe attack, took the salicylates readily,had a copious serous effusion in the pleura, but has recovered

, completely -T am Sirs. vnnra faithfully

C. A. RAYNE, M D. Lond., &c.

THE SETON IN MÉNIÈRE’S DISEASE.To the -Editors of THE LANCET.

SIRS,-Referring to Dr. T. Wilson Parry’s very interestingcommunication, may I be permitted to point out that Idescribed a case of Meniere’s disease successfully treated bythe seton in the British Medical Journal of March 29th,1902, p. 806 ? It was suggested to me by Mr. WalterWhitehead’s remarkable success in the treatment of

I migraine. -- _ - I am, Sirs, yours faithfully,_-__--_UOLIN CAMPBELL.

THE ADULTERATION OF COD-LIVER OIL.To the Editors of THE LANCET.

SIRS,-I am perfectly in agreement with Mr. E. J. Parryin his contention that the value of cod liver oil is dueto the facility with which it is digested and absorbedand not to any active principle. In this sense hisuse of the word "traditional" is justified and there-fore possibly other fats have not had their fair shareof consideration. Virol, to which he refers, the fattyportion of which is chiefly supplied by bone-marrow, isa substance which we have largely used at the Children’sHospital here with excellent results, young children taking itwith facility and advantage. Possibly it would be well,remembering how scarce and expensive cod-liver oil hasbecome, if we were to investigate the whole subject of thevalue of the various available animal fats de novo anddetermine their relative advantages on their merits alone,.eliminating any element of tradition.

I am, Sirs, yours faithfullv.L. A. PARRY, M.D. Lond., F.R.C.S. Eng.

NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

Vaccination amongst Ancient Hindus.-Increase of Plague.A POINT of immense historical interest has lately been

referred to by a writer in the Madras Mail. It practicallyconsists in the discovery that vaccination as we know it, andnot merely inoculation for small-pox, was practised inancient Hindu days. In the "Sactaya Grantham," an

ancient treatise attributed to Dhanwantri, the writer afterdescribing nine species of small-pox lays down rules for thepractice of inoculation (? vaccination). The translation ofthe passage is as follows : "Take the fluid of the pock onthe udder of a cow or on the arm between the shoulder andelbow of a human subject on the point of a lancet andlance with it the arms between the shoulders and elbowuntil the blood apt ears; then mixing the fluid with the,

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blood the fever of the small pox will be produced."Again, " The small-pox produced by the fluid from theudder of a cow will be of the same gentle nature as theoriginal disease, not attended by fear, not requiring medicine ;the diet may be according to the pleasure ot the patient whomay be inoculated once only or two, three, four, five, or sixtimes. The pock when perfect should be of a good colour,filled with a clear liquid and surrounded by a circle of red ;there will be no fear of the small-pox as long as life endures.When inoculated with the fluid from the udder of a cow

some will have a slight fever for one, two, or threedays, and with the fever there will sometimes be a slightoold fit ; the fever will also be attended by a round

swelling in the armpits and the other symptoms of

small-pox but all of a very mild nature. There willbe no danger and the whole will disappear in three days."These extracts are taken from the Madras Conrier ofJan. 12 h, 18).9. Maclean, in the Manual of Administration,referring to Dhanwantri, says that Sanskrit treatises onmedicine bear his name and I am also informed that thereis a Tamil medical work which has been printed known asDhanwantri Cauvyam and which is a treatise on Hindumedicine. I have not yet been able to verify these quota-tions but the writer in the Madras Mccil has kindly furnishedme with the above references and translations.The plague epidemic is steadily increasing with ominous

signs in certain districts. In Central India the deaths are iovar 1000 a week, whereas last year they were numbered intens. In the United Provinces the plague mortality is nearlydouble that of last year and there is a marked increase alsoin the Punjab. The disease seems to be declining in theBombay districts but is developing rapidly in Bombay city.A recrudescence is also showing itself in Calcutta.

Feb. 18th.

CHOLERA IN THE TURKISH EMPIRE.

(FROM THE BRITISH DELEGATE ON THE OTTOMAN BOARDOF HEALTH.)

SINCE the date of my last letter on this subject (whichappeared in THE LANCET of Jan. 23rd, p. 255) cholera hasnot been very active in any part of the Turkish empire. Theinfection has, however, reached the important town of Basra,at a short distance from the head of the Persian Gulf, and-occasional cases are-or were till quite recently-reportedfrom Syria. It is clear, therefore, that the cholera infectionis still present over a very wide area, though showing nogreat intensity in any part of that area.

In Bagdad the disease appears to have died out, as nocase has been reported from there since Jan. 7th. The samestatement holds for Kerbela, where no case has beenobserved since Jan. 12th. The extent of the outbreaks inthese places will probably never be known. The sanitaryofficer of Bagdad states that there, and still more inKerbela, a large number of cases occurred which never cameto the knowledge of the authorities. In Kerbela he thinksthe cases were at least double those reported officially. InDiarbekir the last known case occurred on Jan. 9th and inMossoul on Jan. 6 h. At Hindieh, near Kerbela, it was

’reported as late as Jan. 30th by a medical officer who hadjust visited the place that cases were probably occurring Iamong the nomad tribes in the neighbourhood without their

"coming to the knowledge of the authorities. IThe outbreak at B.J.sra seems to have begun on Feb. 6th

though the cases were not seen by the sanitary offier untilthe 8th. On the latter date he telegraphed that he hadseen two women and a child, inhabiting different housesand different quarters of the town, all of whom had fallenill on the 6th and all presenting the symptoms of cholera.The source of infection in these cases has not been deter-mined. The further course of the disease here has beenas follows. From Feb. 6th to 12th there were seven

- cases with four deaths, from the 13th to the 20th there weresix cases with six deaths, and from the 21st to the 28ththere have been as many as 13 cases with 19 deaths. Theleast satisfactory feature in the later reports has been thefact that so many of the cases have only been dis-

covered after death. On Feb. 9th the Board of Health

imposed five days’ quarantine on arrivals from Basra. For

persons acending the river from Bd.sra to Bagdad a tem-porary lax-aret was established at Kermet-Ali, a place about

two hours’ distance from Basra. On the 17th a case

of cholera was observed among the passengers of thes.s. Mossoul which had arrived at the lazaret from Basra onthe 15th. The patient died in the lazaret two days later.On the 20th another case developed among the passengers ofthe same ship and a third case among the crew of a sailingship undergoing quarantine A fourth case was observed inthe lazaret on the 21st. All of these cases ended fatally.Up to the 28th the total cases of cholera in the town of Basraand the lazaret of Kermet All together have been 30 and thedeaths 33.To-day news has been received of the occurrence of a

suspected " case of the disease at Korna, a village at thejunction of the Tigris and Euphrates. No details of this casehave as yet been made known.

In the Aleppo vilayet cholera has been almost, though notquite, extinct during the months of January and February.It will be recalled that a single case of the disease wasobserved in Aleppo itself on Jan. 5th. Another was reportedon the 24th of the same month. No other case has beensince reported. At Aintab, to the north of Alenpo, a fatalcase was observed on Jan. 19th. Bjth of these cases (inAleppo and Aintab) were spoken of as "suspected" only,but all measures were taken as for undoubted cholera cases.

In the Syria vilayet no cases of cholera have been officiallyreported since the beginning of the year, but on the first dayof the year news was received of the appearance of thedisease at N ibe and at Inebe, two places in the district of theHauran. Mention must also be made of a " suspected"case at Latakia on Jan. 3rd. The Hauran districtsuffered considerably from cholera last year. Whether thedisease is still active there or not it is impossible to sayas no definite news has been received from there sinceJan. 1st, but it is to be noted that in successive reports fromthe medical officer on special mission at Damascus it is statedthat news from the Hauran, and particularly from the Ajloundistrict, is "far from precise " or I I disquietii3g " or that thepresence of cholera is rumoured there.The total number of cases of cholera in the Turkish empire

from March of last year to Feb. 22ad of this year is put downat 7652 and of deaths at 6550. The estimate I made in mylast letter as to the extent to which the official totals maybe believed to differ from the actual totals has been thoughtby many to be far too moderate. Some would place the truefigures at double or even treble the reported figures.Constantinople, Feb. 29th.

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

Health Committee.AT the last meeting of the city council the resignation of

Mr. John Parker, inspector of nuisances, was received andaccepted. Mr. Parker had been in the service of the corpora-tion for a period of 22 years, first as an assistant inspectorand since 1885 as inspector; he has always been a most activeofficer and great regret was expressed that the committee waslosing his services. On the recommendation of the healthcommittee, which advised that in a city of the size ofBirmingham there was need for the services of an assistantmedical officer of health, the council created that post andappointed thereto Dr. J. Doig McCrindle. This gentlemanwas also appointed inspector of nuisances of the city ata salary of E300 per annum. Dr. MoCrindle has beenin the service of the health department since June, 1902,first as medical superintendent of the small-pox hospitaland recently, since the decline of the disease, he has beenassisting the medical officer of health. In his new appoint-ment he will be responsible for all measures taken for the

prevention of infectious diseases and wilt have charge of thedisinfecting staff and apparatus. The milk-shop inspector,the lodging-house inspectors (two men), and the canal-boat inspector will also be under his charge. Mr. FrankThompson, who has acted as chief inspector ofnuisances since 1898, has now been appointed inspectorof nuisances and will be responsible for all matters

relatirg thereto, such as the conversion of pan-privies intowater-closets, the repair of defective drains, yards, &c. Hewill have under his charge the 19 district inspectors,four smoke inspectors, and the court cleaners. Thehealth committee has advised the council that, in addition