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"Would that I could draw aside the veil which obscuresthe worse than Paphian temples, where the votaries of

instrumental prostitution crowd to worship. Here an’ observer’ taking the attitude of an ulcer of the os, whichhas existence only in his own brain ; there another danglingthe uterus on a staff, like a hare-bell on a herdboy’s sprig;but these gentlemen are scientific practitioners of medicine,’and as such are applauded." On page 217 he thus describesthe relative position of the testes : "By the exercise of thatwise foresight which characterises so eminently all theworks of the Great Artificer, ’the Eternal Geometrician,’ itis so arranged that in the state of health, under ordinarycircumstances, the one testicle, the left, suspends lower thanits fellow of the opposite side." The work abounds withsuch specimens from the preface to the last page, and wecan only hope that when the author next appears in printhe will have corrected his style.

The Worthies of Cumberland. By HENRY LONSDALE, M.D.London : Routledge and Sons. 1873.

VERSATILE culture and catholic tastes are apt to maketheir possessor indifferent to circumscribed locality. Goethe,for instance, was so cosmopolitan in mind that it is doubtfulif he ever felt the patriotism which glows in. narrower andintenser natures. The tendency of modern civilisation,with its diffusion of knowledge, its displacement of old

landmarks, and its leveling influences, is to foster sucha mental constitution, to sneer down local sentiment as’provincial," and to merge individual character in a fea-tureless uniformity. The late John Stuart Mill deploredthis tendency ; while Carlyle, by his doctrine of hero-

worship, his insistance on the value of the "individual"even to supporting the fallacy that a nation’s history issummed up in the lives of its " great men," has done hisbest to counteract it.

Nevertheless, the leveling roller of common educationand of intercourse more and more facile is asserting itspower, till the distinctive marks that separate from eachother the various types of Englishmen are coming nearerand nearer to the " vanishing point." Not a day too soon,therefore, are the chroniclers of county history at work ingathering and grouping the memorabilia of their respectivelocalities, and in embalming for posterity the fleetingessence of local or provincial character. Among thelabourers in this field. Dr. Lonsdale deserves a high place;and his " Worthies of Cumberland," of which the presentis the latest if not the last instalment, forms as successfulan embodiment as we have seen of the representative fea-tures of a great English county.Wordsworth, Tickell, the Misses Blamire, the Loshes of

Woodside, Dr. Thomas Addison, and the late Mr. H. L.

Pattinson, are the themes of the present volume. The first,and second of these " worthies" are described by Dr. Lons- dale more, we imagine, for the sake of giving completenessto the list than because he has anything to add to whathas already been written of them. But the sketch of MissSusan Blamire, the author of some of the finest songs wehave and a lady of strong and genial individuality, wouldof itself commend the volume to the reading public. The

Loshes, like the Blamires, were also remarkable as a family;and Dr. Lonsdale has given us a group of its more interest-ing members which is certainly a highly successful piece ofliterary portrait-painting. Except incidentally, however,none of them, nor indeed any "worthy" in the book, hasspecial interest for medical men, but Dr. Thomas Addison.Of this most admirable physician, practitioner, and teacher,Dr. Lonsdale presents us with a vivid and life-like sketch.Remarkable as a boy at the grammar-school of Newcastle-on-Tyne, where he acquired such mastery of Latin that he

could take notes of the lectures of the Edinburgh professorsin that language, Addison more than justified the anticipa-tions formed of him, till, after graduating in the Northerncapital with high distinction, he settled in London, andsoon became the life and soul of Guy’s. No azurtnus of thatschool should omit to read Dr. Lonsdale’s eloge of one of itsgreatest teachers-one whose career was an exemplar whichevery medical aspirant must be the better for studying.Dr. Lonsdale’s style - occasionally, as in his well - knownLife of Goodsir, a little odd, not to say amateurish-is

singularly pure in the sketch of Addison: as if, indeed, themantle of his subject’s namesake had fallen on him for theoccasion. We wish, however, that he had given in correcterLatin the inscription on Addison’s bust in the museum ofGuy’s.

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Diseases and Injuries of the Eye. By GEORGE LAWSON.F.R.C.S. Fcap. 8vo. 400 pp. London: Renshaw.

WE congra,tulate the author of this valuable little workon the appearance of a second edition, which is an improve-ment on the first, inasmuch as it has been brought up tothe present state of our knowledge of ophthalmics. Muchold material has been cut out and more than replaced bynew, and, by the addition of nearly eighty new woodcuts,the value of the book has been greatly enhanced. Thearticles on Calcareous Films of the Cornea, Tattooing ofthe Cornea, Cyclitis, Venous Naevus of the Orbit, HerpesFrontalis, and Xanthelasma Palpebrarum are quite new,while those on Conical Cornea, Intra-ocular Tumours, andCataract have been entirely rewritten. The article on

Astigmatism has been much extended, and in its presentform gives a remarkably clear description of the cause of £this anomaly, the readiest method of detecting it, and ofselecting appropriate glasses.We need scarcely say that we heartily commend this work,

which for its size and pretensions contains more informationon the subject of ophthalmic medicine and surgery thanany other with which we are acquainted.

REPORTOF

The Lancet Sanitary Commission

ONSEWAGE FARMS.

No. II.-CROYDON.

THE district of Croydon has grown with wonderful rapidityduring the last few years, and has now a population of notless than 60,000. It is under the supervision of a LocalBoard, which has shown great wisdom and energy in pro-moting the development and improving the sanitary condi-tion of the town. A cottage hospital, with about 20 beds, hasbeen established ; public baths have been erected; and a plotof 36 acres of land has been purchased and devoted to theuse of the inhabitants as a recreation ground, where cricketflourishes in the summer and football in the winter. Almostthe whole district has been sewered, and, by a wise regula-tion, every new house is furnished with a ventilating pipefrom the drain to the outside of the premises. The water-

supply is derived from chalk wells in the middle of thetown. These wells are lined with iron, and are of consider-able depth ; but the water is so abundant that it rises almostto the surface of the ground, and the supply is apparentlyinexhaustible. The water has about 16° of hardness, andcontains much nitrates, but appears from the publishedanalysis to be remarkably free from organic matter. The

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water engines &c. are the property of the town, and the the increase in volume during floods is much greater atpresent supply of water amounts to from 30 to 40 gallons Norwood than at Beddington. The enormous dilution at

per head per diem. times, when the land least requires water, is, of course, an

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-,. ,.’ , .... ,. , z . evil here as it is elsewhere. It has already been to someThe sewage of the population is at present disposed of in extent lessened, and it is proposed to lessen it sti’l furtherthe following manner :-On Beddington farm, three miles by diverting a great part of the storm water to the Bournefrom the town, the sewage of 45,000 persons is applied in brook which flows from Caterham into the Wandle, andland irrigation; on the Norwood farm the sewage of 7500 passes as a closed culvert through the town. As thingspersons is similarly employed; the metropolitan sewers take stand now, there is little doubt that the volume of sewage

. , the of ±t. it- applied to the sou both at Beddington and Croydon is toothe sewage of about 6000 ; and the rest of the population, applied to the soil both at Beddington and Croydon is toolarge. It is true that it does not appear possible to connectabout 1500, scattered in outlying places, has as yet no any definite ill-effects with the present system, but the mostdrainage.

’

extreme caution is required in dealing with a matter inBeddington Farm.-This farm consists of about 500 acres; which the risk is so apparent, and it is certainly incautious

but only 420 acres are under irrigation, so that each acre to flood the crops, herbage, and all, with sewage as they arereceives the sewage of 107 persons. The dry weather flow

now flooded in wet weather. The necessity for passing thereceives the sewage of 107 persons. The dry weather now whole of the storm water over the land has, moreover,is estimated at 3,500,000 gallons per day, which is at the another disadvantage. It often compels the farmer to con-rate of nearly 14,000 tons per acre per annum. The storm tinue the irrigation of a crop to within a week, or evenflow is about five times as great, at the rate, namely, of three days, of the time of cutting. An interval of at least aabout 70,000 tons per acre per annum. Italian rye-grass fortnight should always be allowed that the plants mayand mangold are the chief crops grown. Throughout the

have time to assimilate thoroughly the faecal matters of the, .

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sewage, and the necessity is even greater when animals areyear 1868-9 the sewage contained on an average 3.827 parts allowed to graze on the grass. Cows, we are told, oftenof nitrogen in 100,000. refuse to eat grass which has been cut too soon afterBetween the town and the farm the sewage passes sewaging, and the cowkeepers know the difference by the

through a filtering-house, where it is filtered, or rather smell.strained, by an ingenious mechanical contrivance invented The comparative merits of the two systems of irrigationby Mr. Baldwin Latham, C.E., who was formerly engineer which are exemplified by Mr. Hope’s farm at Romford andto the board, and to whom the town is indebted in many the two Croydon farms are still warmly discussed. Theyother respects..This consists of a couple of iron cylinders may be described respectively as intermittent downward,revolving on a horizontal axis. They are open on one side, and intermittent surface filtration. The latter is cheaper,and closed by a trellis on the other, and are divided into as requiring no deep drainage, and, when well arranged andcompartments like a dyer’s wash-wheel. The sewage is carefully carried out, it seems to afford sufficient purificationobliged to pass through the trellis, which is kept from for the sewage. Its advocates maintain that it permits theclogging by a stream of water projected against it. The absorption of a larger proportion of the manurial ingredientssludge is in this way removed, and is carried by a screw than the other system, which they say allows on some landsinto a separate chamber from which it is periodically re- a good deal of valuable matter to pass into the subsoil, andmoved, and either applied to the land of the farm, or sold so be lost. On the other hand, the advocates of downwardto neighbouring farmers. The cylinders are turned by a filtration argue that these objections are in the main chi-turbine, which is kept in motion by the fall of the sewage. merical; that when the land is properly prepared, the cropsThe sewage enters the farm by a conduit which, like all take up as large a proportion of the nitrogen as on the

others on the farm, is open. There are no tanks ; the other system, and that the perfect safety afforded by down-sewage goes straight to the crop, pours over the surface of ward filtration more than counterbalances any minor disad-the land amongst the roots; is then carried to a second vantages. Sufficient evidence on these points has not as yetplot, and finally runs off the surface of the latter as effluent been collected; but when we consider the risk that may atwater. It will be seen that this is quite different from the any time arise on farms, like those at Croydon, from neglectdownward filtration with deep under drainage which is or mismanagement, and place against that risk the factpractised at Mr. Hope’s, and other similar farms. The brought out by the British Association Committee, that atfiltration is effected by the stems and roots of the plants, Breton’s farm 40 per cent. of the nitrogen of the sewageand by a few inches at most of the soil. The analyses was removed in the crops, and that the soil gained in rich-made for the Rivers Pollution Commission showed that the ness, we confess that for the present we are inclined to giveeffluent water was of good quality, and contained on an the preference to downward filtration. At the same timeaverage 0’584 parts of nitrogen in 100,000. The samples it must be remembered that downward filtration has not aswe examined were nearly colourless, and free from odour, yet been sufficiently tested by time, and that, whether pro-and throaghout the whole farm we failed to detect the bable or not, it is at any rate possible that a plot of landslightest trace of sewage smell. long irrigated may at last suffer diminution in its filteringNorwood Farm.-On this farm sixty acres receive the and aerating power. Whichever system of irrigation is

sewage of 7500 persons-one acre to 125 persons. The dry finally adopted, we hope that in one respect the good ex-weather flow is estimated at 150,000 gallons per day, which ample of Croydon will be followed, and the sewage appliedwould amount to about 4000 tons per acre per annum. The directly to the soil, and not allowed to fester and putrefy instorm flow is about thirteen times as great - namely, tanks.2,000,000 gallons, which is at about the rate of 54,000 tons The result of our careful inquiries into the sanitary con-per acre per annum. The system of irrigation employed is ditions prevalent in the neighbourhood of the two farmsalmost the same as at Beddington, except that the filtering has convinced us that they have produced no perceptibleapparatus is rough and insufficient, and that a good many ill effects on the health of the inhabitants. The death-rateof the water-carriers are closed culverts. The results ob- in the parish of Croydon during the year 1872 was 1855,tained as regards the purification of the sewage are inferior and the average for the last ten years is 1911. In theto those at the Beddington farm. The effiuent water con- Norwood district, so far from the farm having increased thetains more organic matter, and the samples we saw were death-rate, the rate has, since its establishment in 1865,not perfectly clear. This, however, was, we were assured, fallen from 18’6, the average for that year and the twoan accident due to the fact that some of the gutters were before it, to 13’4, the average for the last seven. Sincebeing cleaned out. The land is stiff clay, and is, therefore, 1866 it has never been as high as 15. In Beddington,ill adapted for surface filtration. We failed to detect any which lies outside the parish, the mortality is said to bebad smell, and the neighbours made no complaints, though equally low, although bad sanitary arrangements prevail inone man told us that a sickly smell might be perceived in the houses. Several small epidemics have been ascribed topassing through the fields on a hot day. In 1868-9 the the farms, but in each case inquiry has proved that farsewage contained 6554 parts of nitrogen in 100,000, and more probable causes were present, and in one case, at anythe effluent water 1-34 parts, rate, the charge has been honourably retracted.Comparing the statistics of the two farms, we see that at We must conclude by thanking the town authorities, and

Norwood the sewage is stronger, and the volume, both in particularly Dr. Alfred Carpenter and Mr. Thomas Walkerdry weather and wet, smaller than at Beddington, but that the engineer to the local board, for the courteous assistance

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they have rendered us. To the energy and intelligence ofDr. Carpenter Croydon is deeply indebted, and its presentexcellent sanitary condition must be to him a source ofsome pride as well as gratification.

PROFESSIONAL SKETCHES

III.-THE CONSULTING PHYSICIAN.

honour a physician," says the Son of SiraGh, "withthe honour due unto him for the uses which ye may haveof him; for the Lord hath created him. For of the Most

High cometh healing, and he shall receive honour of theking. The skill of the physician shall lift up his head, andin the sight of great men he shall be in admiration."In all ages of the world physicians have been held in

honour, as the above quotation from Ecclesiasticus and thewell-known eulogy of Homer abundantly testify. It would

seem, too, that a distinction was drawn, even in the veryearliest time, between the skilled physician and the empiricapothecary or pharmacologist. One was regarded in thelight of a clever general and tactician, who, by wisdom, fore-thought, and prudent counsel, could compel disease to for-sake its strongholds and surrender at discretion; the otherwas looked upon merely as a wielder of lethal weapons,who, if unguided by the judgment of his superiors, mighteither fail in his object or succeed only in destroying theenemy by the simultaneous destruction of the very citadelitself. Among learned professions, that of the physicianhas in all times held its own, and the consulting practi-tioners of the healing art have invariably been admitted tothe enjoyment of a high social position. Until compara-tively recent times Medicine took decided precedence defacto,as she still does de jure, of her twin sister, Surgery. Therewere at all times, no doubt, chirurgeons who by force ofcharacter and sheer ability rose to great eminence and en-joyed posts of high honour; but these men, who were fewand far between, shed a lustre on their calling, and didhonour to it, instead of receiving honour by the mere factof practising it; and it may be said that they rose in theestimation of their fellow-men in spite of the drawback ofpractising what then was little better than a brutal and abloody handicraft. It was not probably till the time of

Wiseman, the serjeant-surgeon of the "merry monarch"and the "father of British surgery," that surgery as ascience and an art per se began to have any locus standi inthis country; but we have evidence that at least two

centuries before that time there were British physicianswho were celebrated not only for their learning, but forthe influence which they exercised in the State.The early physicians were all men who had received the

highest education which was then obtainable, and we findthat Linacre, the founder of the College of Physicians, andhis immediate successors, Caius, Browne, Harvey, and

Sydenham, not only studied at Oxford or Cambridge but,subsequently, on leaving the universities, travelled abroadin search of such information in the healing art as the morerenowned seats of learning on the Continent could afford.The consulting physicians of the present day, those whoessay to take what always has been considered the highestwalk in medicine, are the inheritors of a profession whichhas been regarded for many ages as ennobling in itself, andwhich has been adorned by many men remarkable alikefor their Christian virtues, great learning, and scientificacumen.

It will hardly be conceded at present, as Johnson sayswas the case in his time, that " a physician in a great cityseems to be the mere plaything of fortune." That there

often is, as there always has been, a considerable amountof what we call luck (but luck, be it observed, is generallydue to the intrinsic qualities of the man) attendant upongreat success we will not attempt to deny; but we be-lieve that there never was a time in which the possessorof real worth stood so good a chance of coming to the frontas at present. No man can succeed as a physician unlesshe possess the requisite qualifications, and it is evident that;a typical physician should be distinguished in the firstplace for his great and extended professional knowledge-knowledge acquired by continuous reading and the pains-taking and scientific investigation of disease in a hospital.That he should know how to use this knowledge and howto give weight to his opinion is of the highest importance;and he should be an adept in so regulating his utterancesthat while, on the one hand, they shall be free from offensivedogmatism, they shall, on the other hand, have no tinge ofvacillation, doubt, or timidity. This just mean is only tobe acquired by constant teaching in a medical school-forof all methods for compelling exactitude in knowledge andin speaking, teaching undoubtedly takes the first and the

highest place. While a physician is making his hospitalvisit, escorted by a troop of students, and while he is offer-ing his clinical remarks to men who, though young, are, ashe well knows, too prone to be critical, he is receiving thatindispensable training which enables him to speak authori-tatively when called in consultation with those who areperhaps his seniors, or at least his equals in years, and whomay possibly hold the not uncommon notion that grey hairsare the one pathognomonie indication of knowledge.The consulting physician appeals to a double public-the

general public, who consult him probably for no otherreason than because they hear his name frequently, andthe professional public, who exercise the most critical sur-veillance over his mental and social acquirements, andaccording to whose verdict the extent of his practice is in agreat degree regulated. The bearing of the consultingphysician towards the general practitioner has immenseinfluence on his success, and the questions asked about himby the latter more often have reference to the " kind of manhe is in consultation " than to the extent of his knowledgeupon this or that class of diseases. " Tact" is the one

indispensable quality, tact which shall enable him to avoidthe Scylla of unnecessarily weakening the confidence exist-ing between the doctor and his patient, while steering clearof the Charybdis of leaving errors uncorrected or of failingto suggest any modification of treatment which mightpossibly ameliorate the sick man’s condition. The bearingtowards the patient and the friends of the patient is equallyimportant, and it should be the object of the consultingphysician to be looked upon as a kind and sympatheticdespot, whose edicts-all intended for his patient’s good-must be obeyed to the letter. By sympathy we needhardly say that we do not mean the uttering of nauseousplatitudes with a set smile, but that only true sympathywhich finds expression more often in deeds than in words,and in those numberless and apparently trifling sugges-tions which are ever present to the truly sympathetic mind,and which, if they but tend to make a bed of sickness moreendurable, are readily appreciated, and not readily forgotten.The great physician of William and Anne, Dr. Radcliffe

who scarcely ever attended a case without insisting firstupon the discharge of the medical men already in attend-ance, and who had the hardihood to tell his royal patientthat he would not have His Majesty’s two legs for his threekingdoms, could hardly have succeeded in the present day.He was, in fact, a hectoring, ill-mannered bully, but hepossibly knew best how to cope with the ignorant obstinacy