29

worst is to lose his temper; if he can keep this he may withperseverance restore order and harmony, but without it alecture-theatre is apt to degenerate into a bear-garden.

After some years spent in hospital work, the 11 brass plate,"which has hitherto proved so little attractive, begins to de-velop a power of drawing patients into the net, and thehappy proprietor finds that people do come to him, insteadof crossing to the great man over the way, whose crowdeddining-room has been his bete noire for years. If, as he canwell afford to do, the young surgeon gives time and atten-tion to the ailments of those who consult him, brings hisknowledge to bear as best he may, and honestly does hisbest, he soon finds that he is fairly successful, and, withoutmaking any great hit, gradually increases his connexion.Then he probably marries, and if his partner have somelittle income of her own, so much the better, since expensesrapidly increase with family cares. To marry before he has

really made a fair start is simple suicide, for he cannot workas a married man in the way he would have done single.Probably now he gives up some of the hard work of teaching,and devotes more time to writing. Papers for the societies,communications for the medical journals, perhaps some workon a favourite subject, now occupy his spare time, and leadto a lengthened consumption of midnight oil. And herelies the rock on which many a reputation is wrecked. Towrite well, to express one’s thoughts in good idiomaticEnglish, is not given to everyone, nor, indeed, have allwho possess the art of writing matter which is worth bringingbefore their fellows. To string together extracts from iother people’s works, with a few twaddling remarks orbadly reported cases of the author, is not the way to writeup a reputation, though the attempt is thus not unfre-quently made. Still less can a ’lasting and honourablename be gained by the frequent advertising of some

pamphlet or petty work with a title appealing rather to thepublic than to the profession. It is not thus that the

leading surgeons of the day have made their mark.And now, as years roll on, the young surgeon gains those

two great boons which years alone will give-age and ex-perience. Fortunately for him, the public can understandthat, for operations, comparatively young eyes and handsmay be as good as older ones; but for consultations thegrey head undoubtedly carries weight. As the seniors athis hospital retire or drop off, he attains those posts whichhis long apprenticeship has so well fitted him to hold; hisreputation rises, his patients increase. If the man is reallya good man in every respect, both professionally and socially,his friends rally round him, he becomes the great man ofthe day, and may, with health, enjoy his honours for someyears. And these honours carry with them no little pleasure.To be successful in the object of one’s early ambition, to becourted by the rich and noble, to be worshipped by one’spatients and pupils, and to be respected by one’s pro-fessional brethren, must gratify most men. Then, again,the solid fact of making a large income and laying by forone’s family has its charm. The consulting-room over-

flowing with patients, the numerous afternoon consulta-

tions, and the frequent operations and journeys, though ’ithey fully occupy the time of the surgeon, and may severelytax his strength at times, have their gratifications also, notleast among which is the prospect of a well-earned autumnholiday, when the society of wife and children becomes some-thing more than a name, and when happy idleness can bewell appreciated. No doubt professional incomes are popu-larly greatly exaggerated, and half the hospital surgeons inLondon are supposed to emulate the traditional thoughprobably apocryphal £ 22,000 of Sir Astley Cooper. Tomake .65000 per annum for any number of years, a surgeon ust be very successful, and it is only a fevF of the masters fmust be very successful, and it is only a few of the masters

of the art who ever reach twice that figure. No doubt the

surgeons have more "plums" in the shape of large fees foroperations than the physicians, but then to most men theseare few and far between, whilst the attendance on chronicmedical cases is illimitable. Again, popularity is alwaysfleeting-the popular consultee of to-day is eclipsed bysomeone else to-morrow, and it happens too often that alarge practice is enjoyed but long enough to pay off theencumbrances of early years without leaving any greatprovision for old age or for wife and children. It un-

fortunately happens, moreover, that the number of quasi-perfect surgeons is limited. Many a man of great promisewhen young fails in after years, and is content to occupy a

respectable but never a first-rate position, and circumstancesmay prevent an otherwise eligible candidate from main-taining the struggle until his opportunity arrives. And

yet a second or even third-rate position in London is notwithout its gratifications. We owe much to men who maybe said in one sense to have failed-i.e., in making largepractices-but who for that very reason have time to domuch good work in our medical schools and hospitals,who train the practitioner of the future, who act asexaminers of the various licensing boards, and who makesolid contributions to the literature of the profession. To

many men such a life is more agreeable than the constantbustle of the popular consultee, and they find time to culti-vate the fine arts and collateral sciences in a manner whichreflects honour upon the profession to which they belong.

RELAPSING FEVER IN THE METROPOLIS.

IT may be useful at the present moment, now that re-lapsing fever has reappeared in South London, to recall thechief facts of the outbreak of which the recent cases seemto be a recrudescence. The first known case occurred inthe metropolis in July, 1868, and it was quickly followed byothers. These cases attracted considerable attention, for,so far as was known, relapsing fever had not existed inEngland for thirteen years, the previous epidemic of thedisease having ceased in 1855. Dr. Murchison, who studiedthe history of the earliest cases with great care, came to theconclusion that they had probably contracted the disease fromPolish immigrants. Numbers of Polish Jews, residing inWhitechapel, were among the first known to be affected withthe fever, and it was known that the disease had been prevalentin East Prussia and Poland prior to its appearance here.

In 1869 relapsing fever underwent a considerable deve-lopment in the metropolis, and in 1870 the outbreak attainedstill larger proportions. In the earlier months of 1871 thedisease declined rapidly, and before the termination of thesummer it had apparently entirely disappeared. Althoughthe malady was first recognised in the metropolis, it wasnot there that the earliest extensive outbreak appears to.have taken place. From Mr. Simon’s twelfth annual reportwe learn that in the autumn of 1868 there was a remarkableoutbreak of relapsing fever in Tredegar, Monmouthshire;and that the malady subsequently became very prevalent insome of the neighbouring iron districts. At the time the-disease prevailed in the metropolis it extended to almostevery large town in the kingdom; and accounts still reachus from time to time of its existence in some of the large

! centres of industry. Very recently, we understand, it

existed-if, indeed, it does not at present exist-in morethan one part of the Staffordshire pottery district.During the outbreak in the metropolis, it is of great in-

terest to note that a large proportion of the cases admittedinto the London Fever Hospital came from Camberwell. Ofthe state of the patients at the time of admission to thehospital Dr. Murchison has written:-" With rare excep-tions, the patients admitted with the disease into the FeverHospital had been in a deplorable state of destitution, fargreater than that of the average of typhus patients. Even

30

the nurses of the hospital were strongly impressed with thisfact. A large proportion of the entire number were tramps’who had travelled long distances in search of work, andmany of whom appeared to arrive in London with the feveron them. This remark applied especially to Camberwell,most of the 105 patients supplied by that parish havingarrived in the parish only a few days before being broughtto the Fever Hospital. Many of the patients admittedduring September and October had only just returned fromhop-picking in Kent, where they had been sleeping in barnsand under hedges, and eating unwholesome food; severalpatients, for instance, stating that they had eaten nothingfor weeks but turnips and unripe fruit. Hawkers, coster-mongers, and charwomen constituted another large propor-tion of the cases of relapsing fever."From inquiries that we have made, there can be little

doubt that relapsing fever was introduced into South Lon-don this year by a man who had contracted the diseasewhilst hop-picking in Kent. He returned to town in thelast week of September, and was seized with the diseasetwo days after his return. The infection spread to the dif-ferent members of his family, one of whom was receivedinto Guy’s Hospital, and underwent there a typical attackof the disease. From this family the disease spread to thefamily received into the Stockwell Fever Hospital, the his-tory of which we gave last week. No fresh cases of relapsingfever have been received into the hospital, and the eight,cases of which we wrote have, we believe, been discharged.In none of them was there a second] relapse, whichsometimes occurs, and the convalescence was uninter-rupted. We must hope that the two groups of cases

we have reported may prove to have been the repre-sentation of only a limited importation of the disease,which, by attention and isolation, has been restricted withinnarrow limits. But there are indications, even at this mild,prosperous, and healthy Christmas time, that practitionersneed to be on the look out for infectious forms of disease.

It is probably chiefly owing to the recent singularly openweather that the disease up to the present has not extendedbeyond two or three families. But with the accession ofcolder weather we can hardly hope that this quiescencewill continue. It will behove local authorities and their

sanitary officers and the Poor-law authorities to be on theirguard, and prepared to use fully and energetically thepowers they possess for the control of the malady, should itbegin to show signs of active diffusion.

THE SANITARY CONDITION OF MOSELEY AND

BALSALL-HEATH, NEAR BIRMINGHAM.

THE suburbs of Moseley and Balsall-heath, which arenow attracting attention as being the seat of an epidemicof enteric fever, lie on the south-west or Worcestershireside of Birmingham, and are situate in the parish of King’sNorton. The district of Balsall-heath, which immediatelyadjoins the parish of Birmingham, is governed by a localboard of health; but the sanitary authority in Moseley isthe board of guardians of the parish of King’s Norton.

Moseley lies very high, the soil is generally sandy, ormarly, the country in and around is very pretty, and it hashitherto borne a high character for salubrity. Many villasand houses of a high class have been erected there duringthe last few years, and probably no suburb of Birminghamhas increased more rapidly, especially since the MidlandRailway Company, seeing the growing importance of thedistrict, opened a new station there some three years ago.Moseley, lying higher than Balsall-heath, has no outfallfor its drainage except through that district; and as thelocal board of Balsall-heath have already an injunction fromthe Court of Chancery hanging over them for permittingtheir sewage to pass into Sparkbrook, one of the naturalfeeders of the Birmingham and Warwick Canal Company,there is no hope of obtaining relief in that direction.The rector of the parish assembled the inhabitants at a

public meeting on the 27th ult., when a special committeewas appointed to investigate the sanitary condition of thedistrict, and to draw up a memorial to the Local Governmentauthorities, praying them to send a competent inspector atonce to Moseley to inquire into and report upon the causes

of the disease now prevalent, and to advise with their com-mittee as to the best means of abating or removing them.The memorial was presented to the Local Government Boardon the 31st ult. Analyses are to be obtained of water fromtwenty wells situated within the infected district. A sani-

tary medical officer and an inspector of nuisances are to beat once appointed, and all steps taken to eradicate the dis-ease as soon as possible.There is no doubt much typhoid fever at present in

Moseley, though but little has yet been seen of it at Balsall-heath. There are at the present time forty-three cases atMoseley and Balsall-heath; and there have been sevendeaths.

There is no system of drainage in Moseley. The houseshave most of them dumb wells, and into these the water-closets, with which most of the better houses are provided,discharge their contents.The water-supply is chiefly derived from wells, many of

which are doubtless contaminated by percolation of sewagematter from neighbouring dumb wells. The mains of theBirmingham Waterworks Company pass along the chiefthoroughfares of Moseley, but there is no sanitary authorityto compel the householders in those roads to use the Com-pany’s water. The following is the result of the examina-tion of a specimen of water obtained from the pump of alarge villa in one of the best parts of Moseley made by theanalyst of the Birmingham Waterworks Company :-The water was bright, but had much matter in suspension.

It evolved slight fumes of nitrous acid on ignition, andcontained free acid.

Hardness before boiling, 11’2; ditto after boiling, 10’3.Indestructible matter, 15-54 grains per gallon.

Chlorine, 1’76; chloride of sodium, 3’03.This analysis is interesting, inasmuch as it was taken from

a house in which one of -the inmates had, during this epi-demic, died from typhoid fever. This may be considered agood specimen of the well-water of the district. In manyparts the proportion of solid impurities would be far larger.

THE HEALTH OF ST. PANCRAS SCHOOLS,LEAVESDEN.

THE following account by the then medical officer, Mr.Charles E. Little, of the health of the children during thefirst six months in the Leavesden Schools confirms the idea

that, however unsatisfactory the health of the children wasat the time of the visit of our Commissioner, it was muchworse then. The alleged extent of the ulcerations of the

feet, and the statement that the very unusual case of

gangrene of both feet in a child of six (? four) years wasdue merely to cold, are very serious.

" The cause of the excessive mortality during the firstsix months at the Leavesden Schools was, I believe, owingto the bad sanitary condition of the buildings, because theywere opened before being completed, and before any per-manent supply of water had been obtained, so that thedrains and waterclosets were not thoroughly cleansed. Theorders for the clothing of the children had not been carriedout, so that during the frosty weather of 1870-71 they wereinsufficiently clothed. The infirmary and nursing arrange-ments were insufficient, and often the number of childrenupon the sick-list was more than I had means for accommo-dating; and I had great difficulty in organising any sys-tematic medical treatment of the sick. I should think fullyhalf the children of the whole school suffered from ulceratedfeet, partly owing to the excessive cold, and partly to hard,unfitting shoes. I think that this combination of circum-stances tended to keep the health of the children bad.There were a few cases of enteric fever, one of diphtheria,and a few of measles. The children were, as a rule, badlynourished, and had no stamina, and succumbed as soon asattacked by disease. The case of gangrene of both feetarose simply from cold, and the child (six years old) livedfor some weeks after the feet had separated from thestumps."