837

The empiric proclaims that tJw administration of certain

drugs, or a combination of them, is essentially a ’cure’of se

such and such a complaint; but the rightly thinking and of

experienced medical man will tell you to Mcar in mind a

that ’cure’ is not a term to be used by the educated of

practitioner. What can or do we ’cure’ in disorders m

or disease Nothing, I fear. We treat, and watch ftwith care, ’all the ills that flesh is hcir to.’ By is

judicious treatment we may sometimes shorten an attack d.of illness, and probably do so in many cases of sickness ; st

but the mysteries and course of disease are influenced much rr

more by causes over many of which we have absolutely no p:control. Take, for instance, the eruptive diseases of child- dhood or mature life. Do we by treatment cut short the pro- t(

gress of scarlet fever or typhoid fever, or other disorders which tineed not be enumerated ? The late Dr. Wilson, physician to t]this hospital, a great scholar and a man of great observation r

and reflection, was ever strongly opposed to the use of the ii

word. It was he who first impressed me with the importance bof discarding it as incorrect in all our views with respect to 0

the action of medicines. Patients, he would observe, may t’,recover. Recover’ under treatment, but we do not cure’ o

hem, ’ Some credit must be given to Nature for her assist- a

ance in the recovery.’ I Cure’ is the motto of the empiric. p"There is another point of practical importance, gentle- d

men, to which I particularly wish to direct your attention. n

You will have to listen to many a tale or history of a case o

from a patient, or one who in practice may require your s

coöperation. Listen to all that may be told you with atten- v

tion and consideration. But, whatever you are told, be sure to satisfy yourselves that you have facts, and not mere state- ments, to guide your decision, and upon which you have to c

form your diagnosis and decide your treatment. Take v

nothing for granted. Take every precaution to establish in a

your minds the absolute truth of all related to you, and seek 1for yourselves the symptoms to establish that truth. I heard git once said, and it has remained engrafted in my mind, c

that in medicine, as in most other callings, taking a thing i

for granted without satisfactory evidence was often the cause B

of more mistakes than ignorance.’ "Gentlemen, I trust you will not overlook the difficulty c

there is in giving even the semblance of novelty to thoughts iin such a lecture as this-thoughts which have found expres- asion a thousand times by others gone before me on similar toccasions to this. My object has been governed by the adesire to point out to you certain things which I believe to ibe true, to be useful, and of universal application, and if (

anything I have said shall assist in giving a nobler idea of life and its responsibilities to any of you who are now enter-ing en the study of medicine, the purpose I have had in view will be more than amply rewarded. The medical man is 1

often the friend-not infrequently the confidential adviser-ofmany a patient, quite independently of his professional rela- tions. In this we find how highly the man may be appre-dated, not infrequently greatly beloved, and many a time ,gratefully remembered. When in sickness the patient lies

weary and tossing in his bed his mind may be much troubledby some hidden sorrow. The still small voice of consciencemay be whispering something in his ear which adds to his un-rest and general distress. He may need much mental as wellas physical comfort. I do not wish to trespass in any degreeon the province of the chaplain ; but if, in the distress of mind,added to the sufferings of disease, his confidence in yoursympathy and kindness of heart should induce him to referto his mental trouble you have the opportunity of giving aword of comfort spoken in season.

"Gentlemen, my best wishes attend you, and my sincereSlope is that your future will be blessed with health, happi-ness, and prosperity."

--

ST. MARY’S HOSPITAL.

INTRODUCTORY ADDRESS BY DR. A. P. LAURIE.

A PAPER was read by Dr. A. P. Laurie on "The MedicalProfession and Unhealthy Trades," of which the following is<an abstract :-

"In standing before you to-day I must plead completeignorance of what is customary in opening addresses of thiskind, as it has never been my fate to be present on such an’occasion, and I have gleaned very little information as towhat is expected or what is the nature of the subject usuallydealt with. I must confess to having felt somewhat attractedto a discourse on my own department of chemistry and tothe expression of views on the reform and development of

he teaching of that science in medical schools, where iteems to me less might be asked of the student in knowledgeif detail, and more time might be devoted to training bycareful experimental course in the scientiiic method

)f thought, thus helping to that scientific habit ofnind which would be invaluable to him in his’uture career. Tempting as this educational questions, and important a.s the right using of the timelevoted to pure science must be, I have decided to leave thesubject alone, as I have too recently become a teacher ofnedical students to indulge fitly in criticisms of our

present method of instruction. There is, however, a

lepartment of work which falls to many of our studentsto perform in after life, and which I have had the oppor-tunity of examining into somewhat closely, and on which,bherefore, 1 feel that I have some right to speak. Irefer to their duties as certifying surgeons in connexionwith the administration of the Factory Acts. It is

being more and more widely recognised that we look toour medical men to prevent as much as to cure disease, andthough we have not adopted the supposed Chinese methodof only paying them while we are well, yet we call upon themas officers of public health, and in various other ways, toprotect us from ill-health and to devise means by whichdisease may be warded off, so that research into preventivemedicine and into the questions arising from the difficultiesof keeping large and crowded populations in a healthystate are of growing importance. The administration of thevarious sanitary laws is largely in the hands of the medicalprofession, and to them is entrusted the guarding of our

population from the introduction of foreign plagues likecholera, and from the spreading of diseases that are alwayswith us. Furthermore, all the questions involved in raisingand keeping a vigorous and healthy people are in theirhands for solution, so that they might well be named theguardians of the public health. And if it is the duty ofour navy to protect our shores from foreign foes, to themedical profession is entrusted the far more difficult task ofwaging an internecine civil war against intestine enemies.Among the many problems of healthy living to which ourcomplex civilisation has given rise few are more interest-ing or worthy of study than those associated with the growthand development of our industrial system. The necessity forthe rapid and continuous production of enormous quantities ofarticles of commerce has given rise to innumerable difficultiesin connexion with the health of those employed in such pro-ductions. The insidious effects of long and persistentexposure to influences which for a short period would prob-ably do little harm are pressing themselves on the attention.of our medical men and our legislators. For example,the occasional handling of white lead or breathing of a,

vitiated or dust-laden atmosphere is harmless enough, butprolonged exposure to the same conditions produces terribleresults. Attempts, therefore, have been made to meet theseevils by special regulations and Acts of Parliament dealingwith unhealthy trades, and the Home Office, with its zealousarmy of inspectors, does what it can to impose these regula-tions for the preservation of health on the workshop. Butthough much has been done in this direction much moremust be done before results sufficient to satisfy theconscience of the nation shall have been obtained. Fewrealise who have not investigated them how difficultare the problems involved in this question or how in-tricate the whole subject is, and yet it is one which hasreceived comparatively little attention from the medical pro-fession. It was my good fortune to be appointed a memberof the Home Office Committee which inquired two years agointo the results produced on the health of the operatives bypottery manufacture, and I was specially struck by the factthat most of the local medical men of the district who camebefore us as witnesses had so little information to give us.Evidently their attention had never been specially turned tothe question, and they had missed the opportunity affordedthem of making a most interesting series of investigations.There are, of course, many noble exceptions. The name ofDr. Arlidge will always be remembered as a pioneer inthis department, and the researches of Dr. Oliver intothe poisoning in white lead manufacture have pointedthe road to be followed by others ; but in spite ofthese men little has yet been done in the way ofscientific inquiry, with the view of remedying theevils produced under modern conditions of industry.In too many of our industries the life of the worker isone long tragedy of physical suffering, and no thoughtful

838

man can study the physical state of the population inmany of our manufacturing centres without dreading that in i

the struggle for commercial supremacy wo are sacrificing the ‘health and vigour of our people and are obtaining riches at (

the price of racial degeneration. Some may reply, Surely our i

factory legislation has already dealt with these problems,and the necessary steps have already been taken to ward off isuch dangers. It is true that much has been done, and the laws protecting the labour of women and children and the regulations requiring cleanliness and ventilation have been of incalculable benefit to the industrial population ; but the

questions which now arise are more difficult and do not the less press for a solution. The whole of the problems in- volved in the handling of poisonous substances, and in the ibreathing of a dust-laden and vitiated atmosphere, and 1in the working in excessively high temperatures, are

still in most cases awaiting solution. It is true that theHome Office has made vigorous efforts to deal with i

some of them by special inquiry and special rules ; but, speaking as a member of one of these committees of inquiry, I do not fear to say that the result of that inquirywas to my mind merely to state clearly the problems awaiting solution in that particular industry, but not to solve them,and to prove that it was only by systematic research bytrained experts on the spot that permanent and satisfactory results can be hoped for. What, then, is the present stateof affairs ?" :

[Dr. Laurie then proceeded to give a brief historicalr&eacute;sum&eacute; of our factory legislation, adopting as a starting-point the great Consolidating Act of 1878. He continued:] ]

" This brief historical survey is, I think, sufficient to showthat the Home Office has been rapidly acquiring very heavyresponsibilities and complex duties with reference to protect-ing the health of the workers, and that these duties are of akind which it is surely obvious cannot be satisfactorilyfulfilled by the ordinary staff of inspectors. The public aretoo apt to assume that when special rules have been drawnup the work is completed, while it would be more correct tosay it is only then begun. Special rules have not been foundadequate to remove those evils in the past and are not likelyto prove adequate in the future ; they merely form a basis forfurther inquiry and research. And surely the great advancewhich has been made as the result of the inquiries of four orfive expert committees shows how much might be hoped forfrom the employment of continuous expert assistance in thefuture. Let us now look briefly at the reports of some of thosecommittees and see what light they throw on the question.These reports are worthy of study by all medical meninterested in public health questions, and contain a greatdeal of interesting information, but it is impossible to readthem and not feel that the information obtained is inevitablyimperfect and the proposed remedial measures of a tentativecharacter. In fact, in the report by the Potteries Committeethis is brought out very clearly by the committee themselves.They ask to be empowered to continue their investigationsas to the composition of glazes and colours with a view offinding out how far it is practicable to make a glaze thatshall be harmless to those employed and at the same timeshall not injure the ware.’ In another paragraph they say :’ Further information is also required as to the temperatureof potters’ workshops and of stoves at the time of drawingthe ware.’ Further on, speaking of the same subject, theysay: We have already in Rule 7 attempted to deal with thetemperature of workshops, but do not consider the rule inits present shape as final,’ and so on. Similarly the reportsof the other committees are full of suggestions as to modifi-cations of machinery and processes which would result infar more benefit than the special rules, and which, whenadopted by manufacturers, should be carefully watched andreported on from time to time with a view, if successful, totheir ultimate universal adoption. Now, zealous and efficientas the factory inspectors are, they cannot be expected, over-burdened already by the increasing number of duties theyhave to perform, to be able to observe what the effects of thespecial rules are on the health of the operatives, or todiscover which are of value or what modifications are

necessary, for, apart from the fact that they are alreadyoverworked, such observations require a medical training.As an example of a, case where scientific observationis required let me take the Cotton Cloth Act requiringthe regulation of the temperature and humidity of theair in the weaving sheds. This Act, as I have alreadystated, has produced a complete revolution in the methods ofventilating the weaving sheds, and gives the opportunity of

studying on an enormous scale the results of artificialventilation on the health of thousands of people, and thevalue of the new methods as compared with the old. Acareful recording of this experiment would be of the utmostimportance in guiding us in the ventilation of factories andschoolrooms, and yet, as far as I am aware, no one is watch-ing and recording the results, or, if it is being done, some-private enthusiast is engaged in the work, and the Home’Office, having instituted this interesting alteration on the"air supplied to thousands of operatives, with a magnificent.carelessness, does not even watch and record the results of itsown experiment. The same criticism applies to the specialrules which have been applied to other trades, for they all’involve regulations introduced to affect the health conditione-under which the operative works, and yet no observations by-experts are being made to see if they effect their purpose.We have, therefore, most valuable experiments being madeupon this most important subject without any proper recordor criticism of the results. But we can go further than this.Questions are arising and will arise in connexion with these:special rules and the various modifications of manufacturing:processes which are always taking place which the Factory-Department of the Home Office, having no experts to apply-to, are incapable of solving. I know of one case where amanufacturer applied to the local inspector to be relieved’from certain special rules because of certain modificationsin processes of manufacture, and the question was referred;’by the inspector to the Factory Department, referred by thehead of the department to the Home Secretary, and by theHome Secretary to the local inspector, and by the localinspector to the manufacturer, who, being the only expertin the whole chain, gave judgment on his own application..What, then, you will ask, is required to enable the depart-ment to deal with these questions of increasing difficulty,and to advance further in its battle with disease and death ? ?There are two proposals which I should like to suggest, andwhich are, I think, worthy of consideration, proposals deal-ing with the central and the local organisation respectively.in the first place, to deal with the local organisation thereis a body of men to whom I referred in the beginning, thecertifying surgeons, of which sufficient use is not beingmade. Let me begin by briefly stating the present positionand duties of the certifying surgeon. He is appointed by-the Factory Inspector of the district and has two dutiesto perform. In the first place he has to examine all childrenand young persons in his district who are about to be

employed in factories, and without his certificate of fitnessthey cannot be employed. For this duty he receives from2s. 6d. to 7s. 6d. for each visit, and 6d. for each child’examined over five in number, when the examination is madeat the factory, and 6d. for each child when at some place’appointed by him. This is done only in cases when thenumber of children is under five. In the second place,accidents must be notified to him, when he must go and’make an inquiry, and has a right of entry into the factory forthis purpose. A special fee is paid for this also. Now, is itnot possible to extend the powers and duties of the certify-ing surgeon, and, if I may make a further suggestion, his pay ?Would it not be possible to use him to make continuous;observations on the health of the operatives and the effectsof new regulations and report to the Home Office on the!same, and would not the money so expended be well spent,and is it not worthy of consideration whether thestatus and method of payment of the certifying surgeoncould not be improved? I know of one certifying surgeon.who has received exactly 2s. 6d. in fees in three years,in return for which he had to fill up innumerable forms andreports to the Home Office. This can hardly be regarded as,a lucrative appointment. In fact, we have here an expertstaff already in touch with our factory system, and responsiblefor the fitness of the operatives at the beginning of theircareer, which might, if properly encouraged, supply us withinvaluable information ; and, furthermore, in the Factory Actof 1895 a clause has been introduced giving power to theHome Secretary to call on the certifying surgeon to makespecial inquiries, which opens the door to my proposal.But it is not only locally that the expert is required; thework done by the temporary expert committees appointedby Mr. Asquith has shown the value of expert advice. Whyshould not the Home Office have an expert consultationcommittee attached to the factory department, consisting ofmedical men, manufacturers, men of science, and engineers,who should have power to inquire into and report on andadvise on questions affecting the health of the operatives &icirc;

839

In this way much useful work could be done. So far 1 havonly treated of this matter from the point of view of thoperative, but I am sure the manufacturer would alswelcome my proposal. He, too often, feels that he i

subjected to vexatious regulations, involving trouble an

,expense, but which do not go to the root of the matter, bydepartment which, though well-meaning, is ignorant ; andwhile willing to submit to such regulations when evidentl.leading to improvement in the health of his workpeople, he is irritated by restrictions which he knowto be useless. Such an expert committee would giv.him more confidence in the factory department an.

make him submit to their conditions with better graceIt is, therefore, in this direction that I venture tthink the next step in advance is to be made, and, ,conclusion, I would wish to press upon our future medica,men the importance of these questions. Noble as the worlof curing disease undoubtedly is, that of preventing diseas.js nobler, and there are many thousands in our great manufacturing cities the victims of our industrial conditions

living lives of hopeless ill-health, that are looking fodeliverance-a deliverance which is only to be obtained fo,them by men who combine the calm, clear intellect of th,man of science, with a burning compassion for the suffering,of their fellows, a combination of qualities which is to bfound most frequently in the medical profession."

MIDDLESEX HOSPITAL.

INTRODUCTORY ADDRESS BY DR. JULIUS MICKLE.

THE address was chiefly devoted to discussing the mannerin which the knowledge of a simple external object isobtained, and in drawing therefrom conclusions as to theonly proper, natural, and fitting methods of medical study.

In the first place, it was shown that in the mental developmentof children the acquirement of a knowledge of a simple objectis a gradual affair, and only succeeding after many attempts.- That, simple as it may appear, is only arrived at graduallyand after failure of the earliest attempts., so that only littleby little is the knowing achieved ; and any very early error,must be corrected by subsequent experience ; so that there isa process of learning, and of overcoming difficulties. in orderto know the simplest object. Applying this to medical study,it was pointed out that if the natural and fitting method befollowed the process must be gradual, that it must begin with’the most simple, which must be thoroughly mastered beforethe study of the more complex is undertaken. In the second

7place, in knowing a simple object, of a certain class, theremust be a synthesis of the evidence derived from certain sensesconcerned, and a conjunction of that of the several senses’cooperating in the process. The importance of the sensations,of sight, of touch, and of those attending movement wasindicated, and the inextricable manner in which the feelingsof movement are bound up with the visual and tactilesensations was insisted upon. The importance of themovements of the eye and hand in vision and inactive touch was referred to, and the sensations derivedfrom other senses-such as hearing, taste, and smell-were shown to have their part in the process of

-perception of the particular object which was used inillustration of this part of the address. In the applicationof this to medical studies, it was maintained that inthem it is necessary as far as possible to use all theactivities of the mind and to use them in cooperation.’The importance of great width of culture in medicine was’asserted, and the characters were mentioned which anysound specialism must possess, and especially that it mustbe built on the firm foundation of a wide and complete.study of medical and other science. In relation to this, andas examples to follow, were mentioned the wide bases onwhich were built the medical acquirements of two eminentmembers of the profession recently lost by death-one Mr.Hulke, who, having a profound knowledge of general surgery,was also an expert in ophthalmic science, was of greatTepute in palaeontology, and of very considerable attainmentsas a linguist. The other was the late Dr. Bristowe, who, toa profound knowledge of general medicine, had addeda special knowledge of pathology, and of diseases of thenervous system, abdomen, and skin. In the third place,for accurate knowledge of the simple object it was

shown that there is a process of search for accuracy, aprocess (so to speak) of working towards truthfulness, so asto secure a truthful mental representation of the object, and

’e e to correct any error of sense by the truthful evidence of otheri (,, senses. And, moreover, that what is true with regard to these

simple products of mental activity is true also of the out-is comes of all the higher and the highest activities of mindd and their collateral results, and therefore involves thea accuracy of the highest thoughts or ideas. This proved the1, necessity of using in medical research and study the utmosty fidelity, the honest intention of truthfulness to nature, andc- the necessity of correcting any error that may arise by the

critical operation of other forms of mental action. And, inregard to this part of the subject, the predominant importance

d of making medical study as faithful as possible to nature was?. urged, as well as that in medical research and study there;0 should be a perfectly unbiased, fair, consistent, judicialn frame of mind, employing in its service all the modes of

mental action, and honestly seeking to attain that which isk true ; that, in a word, medical study should be an honest,,e consistent, persistent search for truth, a,nd made with all thei- powers of the student and practitioner.s, Other topics relating to the main one were also touchedIr upon.

-

ST. BARTHOLOMEW’S HOSPITAL.

INTRODUCTORY REMARKS TO THE COURSE OF MEDICINE

BY SIR DYCE DUCKWORTH.

" In beginning to-day the course of systematic lectures onthe Practice of Physic, I have little to add to the introdue-

tory remarks I ventured to offer to those who sat where

you now do at this time last year. I then counselled the

importance of systematic prelections in opposition to :t

modern, and still prevailing, opinion that the day for sucha method of teaching had passed by, and that the best

training in medicine was only to be gained by an expan-sion of the tutorial system and by assiduity at the bedsideof patients. I entirely accept both of the latter methods,and we afford you in this school the largest measure of eachof them. But I no less strongly insist on the great valueto you of a diligent attendance on systematic lectures inmedicine, surgery, and midwifery, in addition to your tutorialand bedside work. You need all of these. Our svstematiccourses are now shortened and disencumbered of much thatwas imported into them in my student days, and I ventureto believe that you may gather much from the experienceof your senior teachers, which, be it remembered, reposeson a larger basis of observation than can be had fromeven the fullest hospital opportunities. I may here andnow tell you of the activity that is on all hands prevalentin research bearing on practical medicine. Almost everyproblem is the subject of careful inquiry, and these pursuitsare followed with a remarkable degree of industry by an armyof trained investigators. We note the patient scientificresearch student, working often with no other prospect thanthat of the hope of discovering the secrets of Nature, notseeking mere results, but for the precious kernel of truth.And in labours such as these how little do we thinkof the failures and disappointments that always befallhonest investigators-almost heartbreaking when the ex-

penditure of time and effort is considered. We seldom,indeed, hear of these, but now and then we have

the curtain lifted and the light let in with startlingeffulgence. A line of thought such as this leads me at thismoment to recall to you the glorious life-work of that

splendid French savant so lately taken to his rest amidstthe regrets and affection of his compatriots and ofscientific men the world over. The life of Louis Pasteur was

in every sense a full one. Though not a member of our pro-fession, he probably did more for practical medicine and

surgery than all the physicians of this century. This is notthe time, nor am I the person, to descant at length on thetriumphs of his patience, perseverance, and genius. You are

familiar already with many of them. Unselfish, modest,unspoiled by success, fearless, simple, a fervid patriot, a trueChristian-such was this great and good man. What a

career is his to contemplate in these days of indecent

pushing and self-advertisement, what a magnificent lessondoes his life afford to those who labour for the truth’ssake, and what a moral loftiness it sets before all ofus. Think of the aspersions and calumny often cast

upon him, and how he bore with the taunts and pulingnonsense that were hurled at him by silly sciolists.Like the waves beating on the rocks, like the idle wind, tohim all these. He went on his way with the one great aimto seek God’s truth, to help his suffering fellow-creatures,