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nature course of labour occurs. Beware lest a long run ofnormal cases should make you careless or indifferent, andyou are, so to speak, caught napping. There can be nosituation so painful and distressing as when a practitionerreflects that owing to some neglect or oversight on his parta patient suffers from fever or even succumbs to the exhaus-tion of labour. I do not say that all deaths in midwifery prac-tice are preventable; far from it. There are cases which foil themost consummate skill ; there are those which are too com-plicated for some, but which might have been brought to asuccessful termination by others, where, alas, the skilledhelp frequently arrives too late. Many a man in beginningpractice has his future made or marred by the manner inwhich he conducts his first few cases of labour. One of hisdifficulties to be overcome will be a certain class of monthlynurse, frequently met with in the country, in many cases thepersonification of all things septic and objectionable. Theyfio not understand, and will not be taught, the importance ofthe antiseptic douche before and after labour. Theirinfluence with a patient is very great. I do not know whyit should be so, .but there are very few women who willnot listen to an old monthly nurse and do what she

says in preference to what the medical man says. Ishould like to see at least six beds in the hospitaldevoted entirely to lying-in cases for educational purposes,the nurses to be trained in midwifery work, and the studentsto be instructed in the management of normal labour. It is

generally supposed that on commencing his work as externthe student is accompanied by the "junior in charity" to hisfirst few cases. I have not the slightest recollection of sucha thing occurring to me either as extern or as "charity "; butof course all this is different now. Would not the expense ofmaintenance of these six beds be more than compensated bythe good derived from the observation of such cases ? Whenone considers how many cases of midwifery are attended byso-called midwives, by nurses who have had good training inmidwifery, and by general practitioners, it is surely most im-portant that the practitioners at least should have hadample opportunity of learning thoroughly their work in thissubject. Another very important feature in this class ofwork is the management of miscarriage. Many a valuable lifehas been sacrificed and many years of suffering and miseryhave been brought about by making light of a miscarriage.That terrible scourge of lying-in women, puerperal fever,will surely be relegated ere long to the list of preventablediseases. Due amongst other things to decomposing lochiabathing the raw surface of some overlooked rent in the peri-neum, direct contact of the medical attendant with an infec-tious case is the means of inoculation. Absolute antisepsiscan alone rid us of this blot on our work. I should like tosee established in connexion with Guy’s Ly ing-in- Charity acollective investigation of several points in midwifery prac-tice, directed by the obstetric physicians and worked at bypast students in general practice. Many of us would beknown personally to the directors, and by a little organisationI am sure that great and valuable results would be forth-coming. Then, again, how lax are we general practitionersover the matter of a lying-in woman getting up; the ninth dayis what the old women will tell you. Have you ever seen theuterus of a woman who has died about a week or ten daysafter delivery? How far had the process of involution goneon ? Would a surgeon discharge an amputation of the thighon the ninth day And yet this is what we tacitly do. How

many cases of prolapsus uteri are due to too early gettingabout after a confinement? Are not some of us generalpractitioners to blame somewhat for this ? I take this

opportunity of saying a few words, based on severalhundreds of cases seen in general practice, about one classof women-those who are suffering from ansemia. I havecome across a good many, and my experience of themis that they are bad subjects for parturition ; theysoon become exhausted by the pains ; they cannot bearan amount of haemorrhage which to an ordinary womanwould be trifling ; they cannot safely be left at theusual time after delivery ; they are prone to post-partumhæmorrhage. Briefly, whenever you know your futurepatient to be anæmic be on your guard. I will not saymore on this important subject of midwifery than to begof you to set this motto before yourselves in every case, Absolute cleanliness.’" "

[Mr. Stephens then spoke eloquently of the importantposition occupied by the general practitioner in the com-munity, and of the necessity that the medical man shouldrecognise the delicacy of some of the parts he has to play,and concluded as follows :]

"All our leading public men, from Mr. Gladstone down-wards, are constantly saying that the medical profession isI rising in power and influence and general respect’ year byyear-that the profession is becoming more powerful and moreimportant as time goes on. We have each to take our shareof the responsibility in our own community, and very often themedical man has to take the lead ; and the reason why hisfellow men look to him to lead them is because his hospitaleducation has qualified him well for the task. The nationshould be proud of the medical schools of England. Gentlemen,one of the rules of the Physical Society, for which you will bethankful when your turn comes, is that no paper shall lastlonger than thirty minutes. I have already exceeded thattime, and only your kindness and sympathy can prevent youfrom saying you are tired. Much that should have been saidon medical education has been left unsaid ; much has beensaid which would have been said better by many another.I can only wish that my paper, to which you have so patientlyand courteously listened, had been more worthy of thisoccasion, this place, and this audience."

ST. MARY’S HOSPITAL.INTRODUCTORY ADDRESS BY DR. SCANES SPICER.

AFTER a cordial greeting to new and old students theretention of the ceremony of the introductory" was urgedas a convenient excuse for the annual reunion of all interestedin the Medical School. The various reasons for selectingmedicine as a profession were considered. There has been

(said the lecturer) an excessive amount of high falutin’about disinterestedness and philanthropy in connexion withmedicine, as if medical men had a monopoly of thesevirtues. There is no record that the Good Samaritanwas a physician. Boasts about our unselfishness are toooften associated with an affected reticence concerning thebusiness aspect of medicine, about which there is no groundfor concealment or shame. If we only practise commonhonesty-the rule, in spite of the insinuations of cynics withinand without the profession-the business aspect in no waydetracts from the nobility of medicine as a vocation. Thefield of medicine is thoroughly overstocked, yet mostmedical men who can once get established secure a comfort-able livelihood. Those who want to grow rich should avoidthe profession. The social advancement of the medical

profession of late years has been remarkable, and hasbeen parallel with the wide general culture and interestsof the average modern physician, who is something morethan a mere prescriber of physic. Medical men are findingtheir way more and more into Parliament, into the PrivyCouncil, and into the National Government. It is a grievancewith the profession that it is not directly represented inthe House of Lords, where the counsel of medical menwould not only add to the efficiency of public work butsignalise the national recognition of the value of Medicineto the community. It is, perhaps, not unfortunate foras that we share this injustice with the Press ; and if,in seeking for a redress of this anomaly, the Press andMedicine were to combine their forces they might suc-ceed in "mending the House of Lords" to the extent ofremedying this injustice. Among the chief reasons forthe hereditary adoption of Medicine as a profession isthat a medical father sows the seeds of curiosity in hisboy’s latent faculties, tends the bud of awakening thought, .

and watches the blossoming of an ardent passion for thedevotion of life to the elucidation of nature’s mysteries.The new students were congratulated on having selectedSt. Mary’s Hospital as their school for study, and thereasons for the progress of that hospital to its presentposition among the metropolitan hospitals were examined.Every student should arrange his early studies so that hecan obtain an M.D. degree in due course. So few obtainthe M.D. degree of the University of London because therelation of the Matriculation Examination to future medicalgraduation is not known to parents and teachers. Studentsintended for Medicine are thus not directed in the rightcourse at a sufficiently early period of their general educa-tion. If this knowledge were more widely diffused, theclamour by the medical profession for a new University orfor an easier M.D. degree in London would practically cease.It is much to be regretted that the University of London,in its present form, has not that controlling influence overmedical education and graduation which a great Universityin this metropolis ought to have ; and it is with somehope that all who wish to see every London student takethe degrees of M.B. and B.S., and in due time proceed to

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the M.D., are looking forward to the appointment of the

Statutory Commission to effect the reorganisation of the

University. The obstructive action of Convocation in resistingreform was to be deeply regretted. The nomenclature of thedifferent classes of the profession needs thorough and radicalrevision. In the first place, all practitioners educated inLondon who have attained a certain seniority should be ableto take an M.D. degree in London without more difficultythan those educated in Scotland and Ireland can take theirM.D. at home, and so be entitled to call themselves "Doctor."In the next place, the absurdity of calling a general prac-titioner, a gynaecologist, or a laryrgologist a surgeon ratherthan a physician, or vice versâ, is apparent; while all mightequally be M.D. s. It was suggested that in order to giveofficial recognition to special skill, prolonged research, or

eminence as a teacher the new University might grant titles,corresponding somewhat to that of privat.docent in aGerman university town, such as " Specialist " or "Univer-sity teacher"; and, to mark still greater experienceand distinction, the title of "Professor"; such titles notto be used by anyone unless conferred by the University.Advice was given as to methods of work and on the curri-culum of study. Early practice in the use of all the various" ’scopes" and speculums was insisted on, in order to avoidthat sad resort of ignorance, only too often heard-the state-ment, "There is nothing the matter." Whereas a thoroughknowledge of the profession is an indispensable condition ofsuccess, it requires much more than this to make the successfulpractitioner. Among these accessories are a sympatheticmanner, cheeriness, and earnestness. The patient shouldalways be treated before the disease. Hope is one of our mostvaluable remedies. The expectation of a good result is oftenhalf the battle. It should be the practitioner’s undying resolvealways to make the patient’s welfare his first consideration,to give to his case his best thought and skill, and not to

grudge his time in order to restore him to health as qaickly,pleasantly, and safely as lies in his power. When in generalpractice he should not shun consultations. Patients are toowell informed now-a-days to believe any of us infallible. Aconsultation is the means of giving the patient confidence asto the management of his case, and a second opinion is sure

to throw some fresh light on the subject. In referring a caseto a specialist the practitioner should always make it quiteclear to him whether the case is sent for treatment or for anopinion only. The increase and development of specialism areamong the most striking facts in the medical history of thelatter half of the present century. Specialism is destined toplay an even more important part in the development ofmedical art. Among the advantages of specialism are thedetection of abnormalities overlooked by, invisible to,or unappreciated by the occasional observer ; the slow,but sure, scientific advance from constant concentration ofthought on one branch; the high degree of operative skilldeveloped by constant practice and repetition of similar

operations ; the possibility of the specialist keeping wellabreast of the tide of advancing knowledge in his branchand giving his patients the benefit of it; and, lastly, thatthe practice of a specialty gives more opportunities forleisure, and hence for cultivating other interests thanmedical ones. Specialism was defended from the charges ofshallowness, self-sufficiency, and unscrupulousness thathave been brought against it. All men who desire to becomespecialists should acquire a wide general experience beforespecialising. It has been well said that the modern specialistdoes not represent a fraction of medicine only, but the wholeand a fraction more. Although he is a special cultivator ofone branch, he is a complete clinician on the whole subject.Attention was drawn to the remaikable development attainedin less than forty years in the specialty of diseases of thethroat and nose, due chiefly to the truly marvellous resultsof local treatment-e.g., in post-nasal adenoid growths, indiseases of the nasal accessory sinuses, and in the variousforms of obstruction of the nose, which condition, after longneglect, has at length obtained the same respect as a blockedwindpipe, strictured gullet, or any other choked channel. Onthe Continent there is hardly a university without one or moreprofessors of the specialty of nose and throat diseases, andthere are well-appointed clinics-a marked contrast to theindifference and neglect which this branch meets in theUnited Kingdom. Among the latter-day results of bac-teriology the new antitoxin for the prevention and cureof diphtheria deserves special mention. Specialism nowenjoys, more than ever before, the respect of the thinkingmembers of the profession and the public ; but there is

need for still further rapprochement between specialistsand the general body of the profession in the interestsof both. Each is necessary to the other, for no one canbe an all-round specialist. All-sufficiency is as great asnare and delusion to those who profess it, and a positivedishonesty to their patients, as the alleged self-sufficiency oithe specialist. The lecturer concluded thus : "Students ofSt. Mary’s, whatever route you select for your voyagethrough life, your early stages as well as your final destina.tion are identical. On this voyage you are now afloat. Formany of you this day has the good ship been launched intothe stream. At first you run with the current, with beaconlights to left and right, and with skilful pilots who know theshoals and sandbanks to counsel you. Choose well yourcrew. Make Principle your chief mate and Duty you?boatswain. Place Wisdom at the helm, Hope ever at theprow. Soon will you all pass the haibour bar and be outon the flowing main. Then, with Honour as your pole-starand Conscience as your compass, may favouring breezes andflowing tides await you, and bear you to the islands of GoodFortune and Success; there may you find those pearls of

great price-Esteem, Contentment, and Peace. May thesunshine of Happiness ever attend you, but be not down-cast at lowering clouds or adverse gales ; the clouds will lift,the winds will cease to blow. Times of storm and stressmay come. Let not your heart fail you. With your trustycrew aboard you will weather the storm. The best ship mayspring a leak and let the waters of Sloth into the hold ; thenpipe all hands to the pumps, and let Resolution mend thebreach. Monsters of Avarice, Envy, and Jealousy may besetyour course and try to wreck your craft ; then keep on yourcourse straight in the path of rectitude. Good mariners the anchor’s weighed-your sails are set. Speed on yourcourse.

ST. THOMAS’S HOSPITAL.

INTRODUCTORY ADDRESS BY THE REV. W. W. MEBET, D.R

TnE prizes for the past year were distributed by the Rev.W, W. Merry, D.D., Rector of Lincoln College and PublicOrator in the University of Oxford, who in a brilliant andwitty speech gave some good advice to the students. One ofthe happiest hits in his speech was a humorous allusion tothe geographical position of the hospital buildirgs. Here, hesaid, we have a real example of a building placed betweenChurch and State (surely a typical site for a hospital).Dr. Merry alluded, of course, to the Houses of Par-liament to the north and Lambeth Palace to the south.As common ground upon which he and his hearers mightmeet, he dilated upon some of the criticisms of Plato uponthe medical and chirurgical art in the days of Homer. That.

philosopher praised the rough-and-ready treatment which thewounded heroes received before the walls of Troy and con-demned the medical practice of his own day as a system of"coddling." In his ideal commonwealth Homer had no

place for invalids, and the great physician was Work, whowould either kill or cure. As Socrates said: "Whencitizens grow indolent and intemperate, then courts oflaw and hospitals are established, and the arts of the

lawyer and physician give themselves airs, and new

names are invented for the diseases of those careless liverswho fill themselves with winds and waters like a marsh."The magic of sympathy must be the physician’s motto. Hehad opportunities of access and openings for friendly counselthat ministers of religion might often look for in vain, oppor-tunities which if properly taken advantage of would oftensave a life in more senses than one. The real sanctificationof a medical man’s work was sympathy for the sufferer andreverence for his troubles, mental and bodily. Dealirg withthe subject of examinations, Dr. Merry reminded his hearersthat examinations were merely a test for the progressof education. Book work should have actuality givento it by observation and experiment. Half the neivousnessknown to examiners as the sure precursor of failure wasdue to the attempt to learn up a multitude of answers inthe hope of utilising some percentage of them when beforethe examiner. The cultivation of some taste outside pro-fessional work, either in art or music, Dr. Merry thoughtwould conduce to a flexibility of mind that would obviatesuch nervousness, and he reminded his hearers that a changeof work often brings more refreshment than would be affordedby the same amount of rest. In these days of the well-puffedpill, the patent syrup, the expectations of rejuvenescence