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closed the eyes just opened upon a new world of love andhappiness ; they have bowed the strength of manhood intothe dust; they have cast the helplessness of infancy intothe stranger’s arms, or bequeathed it, with less cruelty,the death of its dying parent. There is no tone deepenough for regret, and no voice loud enough for warn-ing. The woman about to become a mother, or withher new-born infant upon her bosom, should be the objectof trembling care and sympathy wherever she bears hertender burden or stretches her aching limbs. The very out-cast of the streets has pity upon her sister in degradationwhen the seal of promised maternity is impressed upon her.The remorseless vengeance of the law, brought down uponits victim by a machinery as sure as destiny, is arrested inits fall by a word which reveals her transient claim formercy. The solemn prayer of the liturgy singles out hersorrows from the multiplied trials of life, to plead for herin the hour of peril. God forbid that any member of theprofession to which she trusts her life, doubly precious atthat eventful period, should hazard it negligently, unad-visedly, or selfishly ! ’

"

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UNIVERSITY COLLEGE.INTRODUCTORY ADDRESS BY DR. RAMSAY.

DR. RAMSAY, in opening the session of the Medical

Faculty, took for his subject the manner of thought ofthe middle ages, as regards science and medicine. He

gave a 1’ésumé of an essay of the Benedictine friar, BasilValentine (born 1394) on the "Microcosm."

" In this essay,the triad division of the Deity (Father, Son, and Spirit), ofman (spirit, life, and body), and of matter (salt, sulphur,and mercury) are quaintly compared. The " matter andform " of the earth were quickened by " motion and

mobility," and to these was added " imagination " to com-plete the marvellous structure. "The living spirit is themercury of man ; hence there are two principles, mercuryand sulphur ; and as to what man shares with other flesh-to wit, body and bone-here salt forms a third principle."The essayist next explains, according to his views, thetransformation of matter from vegetable to animal, and,again, from animal to vegetable, exemplifying his remarksby considering the manner in which a cow is nourished bygrass, and tracing the fate of the products of the cow, till,as manure, they refertilise the soil. The function of theair is next alluded to ; how it causes laughter by invigo-rating the liver, how it prevents "pricking and pain" byits action on the pancreas, and how it prevents sicknessand death by nourishing the lungs. The method of com-bating diseases is contained in the apothegm similiasimilib1.ts ezcran2cr and it is shown how principles pos-sessing medical virtue can be extracted from the humanorganism, from minerals, and from plants.The lecturer then alluded to the conceptions which

underlie such thoughts as those of Basil Valentine; how heand others of his time believed certain numbers andgeometrical figures to possess perfection; the false use madeof analogy, which is, indeed, the basis of all science, sinceto 7,now is only to refer the object said to be known to acertain class, with the numbers of which it exhibits analogy;the deference paid to authority by the ancient writer; andhis use of words to which no definite meaning can beattached. Certain lessons were, however, to be learnedfrom the anci^nts; among others, the necessity of taking apersonal view of the problems of science, and of con-

sidering things in all their bearings. The lecturer nexttraced the connexion between chemistry and medicine,and pointed out that it is as essential to possess know-ledge of the composition of the body as it is to knowits structure and its functions. The anatomist studiesthe structure of the body; the chemist the composi-tion of the various parts, their methods of interacting,and the changes which they undergo on treatment withother substances ; while the physiologist busies himself withthe functions of the different parts resulting from theirstructure, composition, and changes. The value of chemistryas a preliminary training for medical men was then insistedon, and it was remarked that those faculties of mindrequisite for chemical investigation are the same as thoseexercised every day by the practitioner. The lecturer thenstated as his opinion that, while the amount of chemistryrequired to pass the examinations of the conjoint boards is

of use only as a mental training, the requirements of theUniversity of London are such that a diligent student isprepared for the intelligent study of physiology andpathology.The lecturer concluded as follows: " There is no doubt

that we English are in too great a hurry. We want to acquireour knowledge by a short cut. What in England is scampedover in nine months, the German linger over for two years.And the result or the cause (I know not which) is that, whileour students, as a rule, read to pass their examinations,the Germans read to acquire knowledge. One fundamentaldifference between their system and ours-which is thoughtby them and many of us to account for the difference inthe aspect of mind between their students and ours-is,that their teachers examine their own students. Theexaminations thus lose that formidable aspect begotten ofthe dread of the uncertain which ours possess. Theacquisition of knowledge is best attained by intimate con-tact between teacher and taught, and that knowledge isbest tested by the teacher. It is true that the Germansystem may lead to corruption, but they provide a remedy.By their system of co-examiners and extramural teachers,the possibility of the partiality or incompetency of a

teacher is excluded. May we hope that an opportunitywill soon be afforded us of trying their system?" Thequaint words of the Benedictine friar were quoted in con-clusion : "Only knowledge and experience, and thoroughinvestigation of nature, make a trustworthy physician; yetonly next the Creator, through whom all things happen, inthe beginning, now, and for ever."

ROYAL VETERINARY COLLEGE.

ON Oct. 1st the sessional course of instruction was com-menced at this College in the presence of a large number ofstudents and many visitors from the medical and veterinaryprofessions. Dr. George Fleming, C.B., chief of the ArmyVeterinary Department, occupied the chair. The inauguraladdress was delivered by Professor Brown, C.B., the

Principal of the College. After a few words of welcome,the lecturer remarked that an opening address was an

embarrassing task, mainly on account of the vast numberof important subjects which presented themselves for con-sideration. The present age was distinguished as a timeof scientific inquiry. Dogmatic assertion, so charac-teristic of the older schools, had given place to hesitantforms of expression and a tentative medical policy.The only advance which was claimed for the medical artwas exhibited in the general disbelief in the specificefficacy of drugs, and the adoption of an expectant planof treating acute disease. Meanwhile, as medicine was.modestly retiring, seemingly bent on a policy of self-effacement, surgery, with steady and rapid strides, wasforcing its way to the front. No abnormal growth couldhide itself from the knife of the accomplished operator,cover a tumour with nerve substance, and bury it in thecentre of the brain. Its discovery and removal were a simpleand graceful exercise for the mind and hand of the skilfulsurgeon. One of our great art critics had said that thebrush of the finished artist moved within the thousandthof an inch, and that no touch could be wrongly orwantonly made without marring the work. But the artof the perfect operator reached a higher point than thiswhen his polished blade moved among vital structures,and his patient’s life depended on the accuracy of his

guiding hand. Experimenturn fiat ira cozpore viti, andveterinary science might claim that the vast developmentof the art of surgery was the outcome of experiments onthe animals which were the proper patients of the veteri-nary practitioner. It had not always happened that themedical man and veterinarian had been associated in theinquiries in which both professions were intimately con-cerned ; with whom the fault lay was a question whichcould not be answered offhand. Possibly both professionsmight agree to accept the blame as the first step towardsbetter things in the future. The lecturer then discussed theprominent medical question of the day- the communicabilityof certain maladies between man and the lower animals,and the importance of careful and critical observation offacts was urged. It was pointed out that the theory of theanimal origin of diseases affecting the human being was arevival of an idea of the older pathologists, a theory to be

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tested by extended and cautious inquiry by members ofboth professions specially qualified for the work; and oneaim should, at all events, be kept in view by both-namely,to seek to discover in how many points they could agree,rather than to multiply the cases in which they felt boundto differ. Referring to the arrangement for the course ofinstruction, the lecturer sketched out an outline of thesystem in which the student should conduct his work, andconcluded by remarking that he had been fortunate insecuring the aid of some distinguished scientists, who woulddeliver special lectures during the session to the seniorstudents on various branches of pathological investigation.He had only to mention the names of Professor VictorHorsley and Dr. Klein of the Brown Institution, Dr. Crook-shank, Professor of Bacteriology of King’s College, Mr.Watson Cheyne, and Dr. Fleming, the principal veterinarysurgeon to the Forces, to convince them that an intellectualtreat was in store.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

MIDDLESEX HOSPITAL.A CASE OF MOVABLE KIDNEY ; NEPHRORRAPHY; CURE;

REMARKS.

(Under the care of Mr. GOULD.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et mor-borum et dissectionun historias, tum aliorum tum proprias collectashabere, et inte’ se comparare.—MORGAGNI De Sed. et Caus. Morb.,lib. iv. Prooemium.

THE operation of fixing a painful movable kidney in itsproper position is one which has not occupied a place insurgical practice for many years. Yet the amount of painand distress caused by the condition demanded from thesurgeon something more than the application of a paddedbelt., and the operation of nephrorraphy or stitching thekidney was suggested, and has been performed with varyingsuccess by different surgeons. In Mr. Gould’s remarks onthis case he mentions one in which a different method wasfound unsuccessful; the operation as performed on this

patient succeeded, as it did in another instance to whichreference is made. We may take it for granted, therefore,that the operation performed as described below will give asatisfactory result, whilst practically unattended by dangerto the patient. For the notes of the case we are indebtedto Mr. F. C. Brodie, house surgeon.

S. S-, aged twenty-eight, married, the mother of fourchildren, was admitted into Queen ward on July 2nd, 1888.She had enjoyed good health all her life until three monthsbefore, when she was suddenly seized with intense pain inthe right loin, shooting down into the right groin andacross the abdomen. These attacks, varying in severity,had been repeated ever since, and she had not had morethan one week of immunity from pain. The pain wasalways increased by exertion, and subsided when she rested.Micturition during the attacks of pain had been frequentand painful, but she had not noticed any change in theurine. The bowels had been very confined

State on admission.—The patient is a fairly nourishedwoman, but the abdominal walls are notably lax. A freelymovable " tumour " is easily felt in the right lumbar region,with a rounded outline, except at the upper and inner edge,where a notch can be felt in it ; the surface is smooth.During a deep inspiration this " tumour" is felt to descendinto the iliac fossa, but during expiration it is easily pressedback, and up into the loin aud under the ribs. When sheturns on her left side, the " tumour " falls forward and canbe easily grasped between the two hands; and if it is com-pressed, pain of a sickening character, and like that expe-rienced in the attacks of pain, is felt. The left kidney isfelt in its normal position, and not unduly movable. Urine:sp. gr. 1015; acid; no albumen. A movable kidney was dia-gnosed, and the operation of nephrorraphy was recommended.

Operation.—On July lOth, the patient having been anæs-thetised, was placed on her left side, and an incision

auou1l iour incnes long was iiiaue in iier rignu ioiii, parallelwith and two inches below the last rib. The muscles andthe lumbar aponeurosis were divided, and the fat aroundthe kidney was pricked through with forceps, and thekidney exposed and pushed well up into the wound by anassistant. A large curved needle, armed with kangarootendon, was passed through the kidney so as to take up abroad portion of its capsule and cortex. Each end of thissuture was then separately passed through the contiguouscut edge of the lumbar aponeurosis. A second suture waspassed in the same way, and then both were tied, theassistant fixing the kidney in the wound all the time. Thewound was then well irrigated with corrosive sublimatesolution (1 in 2000), closed with deep and superficial sutures,a drainage tube inserted, and dressed with alembroth woolkept in place by strapping. The wound was dressed for thefirst time on July 13th; there was then a very slight serousdischarge, but no redness and no pain. The tube wasremoved on July 16th and the sutures on the 20th. She gotup on July 26th, and left the hospital on Aug. 1st, with thewound firmly healed and the kidney fixed in the loin. Shebore the journey to Portland well, and when last heard of atthe end of September had had no return of her old troubles.Remarks by Mr. GoULD.-The doubts that were for a long

time entertained as to the nature of the conditions called"floating kidney" and "movable kidney" seem to beparalleled by those held as to the best form of treatment.When Hahn’s operation was first published, it was hopedthat an easy and safe means of permanently curing theundue mobility of the kidney had been discovered. But itwas not long before reports of the failure of the operationwere heard, and it is not uncommon now to hear surgeonsspeak of nephrorraphy with very little confidence. It is easyto understand that the fixation of the kidney secured im-mediately after the operation may gradually be lost as thecicatricial tissue is absorbed and stretched, and it is there-fore necessary not to trust to this means of fixing the kidney,but to fasten it in its place by sutures which will per-manently hold it. This was forcibly impressed upon me bythe first case in which I was called upon to do this operation.The patient was under Dr. Coupland’s care in the MiddlesexHospital, with very painful symptoms, due, as we thought,to the mobility of the right kidney. At the operation Ihad the able assistance of Mr. Henry Morris. A silksuture was passed through the whole thickness of thelumbar incision, then through the kidney, and out againthrough the thick tissues of the loin. This suture had tobe removed in a few days. The patient made an excellentrecovery, and at first all was satisfactory, her symptoms beingentirely removed. But in three months she returned as bad asever, and I found the kidney had become as loose as before.I ought to add that she had worn a well-fitting abdominalbelt ever since the operation. I then determined to operateagain and fasten the kidney to the lumbar aponeurosis witlkangaroo tendon, which should be allowed to remain permanently ira situ. This succeeded well, and she has hadno return of her old symptoms, nor can the kidney be feltto move. I have met with the same results in anothercase.

The mode of passing the suture is, I think, of importance.If a large curved needle, such as is often employed, is madeto carry the suture at a single sweep, the surgeon is veryliable to tear through the kidney, and even to some extentits capsule. I prefer first to pass the suture through thekidney, taking up as broad a piece of its capsule and cortexas I can, and then to pass each end of the suture throughits corresponding portion of the lumbar aponeurosis. Twosutures passed in this manner are sufficient to hold thekidney firmly, and if they are tied carefully, the chance oftheir cutting out through the kidney, and so not holding itso securely as desired, is reduced to a minimum. A sub-sidiary advantage of this buried suture is, that the woundcan be closed smoothly and accurately by the ordinarysutures. When the kidney is fixed by external sutures,they pucker the wound and interfere with the most rapidand perfect healing. As to the material of the deep sutures,there is room for divergence of opinion and practice. Silk,as being more durable than gut or tendon, would be prefer-able, were it not that it is more difficult to render abso-lutely aseptic than is kangaroo tendon. At any rate thathas been my experience, and the tendon has answered sowell in my hands as a ligature in ovariotomy and as a

suture in the radical cure of hernia, and up to the presentin nephrorraphy, that I use it with full confidence.