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For healthy women to wear corsets habitually for the pur- i

pose of driving stagnant blood from the abdominal viscera lseems to me to be an advantage entirely outweighed by the t

disadvantages of impeded respiration and restricted move- ‘ment ; and I cannot but think that the support of natural smuscles, aided, if necessary, by suitable exercises, attainsthis end quite sufficiently. That a corset, however well- attain

fitting, does impede breathing can be easily tested. Let anywoman attempt to fasten her corset in its usual dimensionswhile holding her chedt in a position of deep or even

moderate inspiration and she will usually fail to do so. Ifshe can do so, which is unlikely, the corset is useless for thepurpose of increasing abdominal pressure.

In conclusion, I would ask at what age Mr. Bigg considersit advisable to begin wearing a corset. If the erect posturedemands it, then we should be wise to put our babies intostays as soon as they begin to toddle. God forbid t

I am, Sir, yours faithfully,CECIL E. FisH, M.B. Cantab.,

West Worthing. Vale of Clwyd Sanatorium, N. Wales.CECIL E. FISH, M.B. Cantab.,Vale of Clwyd Sanatorium, N. Wales.

SACCULI NOT DIVERTICULA.To the Editorr of THE LANCET.

SIR,-It was my good fortune to be present at a demon-stration by Dr. W. H. Maxwell Telling on the disease of thecolon with which you have associated his name inTHE LANCET of Nov. 27th. After his demonstration I

explained my views of the condition, and I believe that theymet with his acceptance. They were expressed in the" Medical Annual " (Wright), 1909, p. 210, as follows:-" Diverticula" of the colon, especially of the sigmoid, have been long

known to pathologists. Only recently has their surgical importancebeen recognised, and chiefly as a cause of left-sided intra-abdominalsuppuration or as " tumours

" of the sigmoid which have been mistakenfor cancer. More obscurity than probably belongs to the subject hasarisen from the use of the term diverticulum as applied to these pro-trusions from the bowel, and small consideration shows that betweenthem and the recognised diverticula there are many points of difference.It seems probable that all diverticula are of congenital origin. All coatsof the intestine enter into their composition. All have a special vascularsupply of their own. They are seldom if ever multiple, and are foundat any age. The vermiform appendix is representative of this type inthe normal subject. Meckel’s diverticulum, due to arrested involutionof the omphalomesenteric duct, has long been recognised as of surgicalimportance, and the existence of diverticula at different portions ofthe gastro-intestinal tract associated with small pancreatic outgrowthshas been recently added to our knowledge of these interesting condi-tions. Of the traction diverticula due to the drag of a limited adhesion,nothing more needs to be said than that they ought to be classedseparately from any other form.The swellings observed on the colon do not answer to our description

of a diverticulum at all ; indeed, their origin is so different that theconfusion caused by calling them diverticula should cease. They differfrom diverticula in that they are never of congenital origin, and haveconsequent]_V notbeen found inyouth; are multiple; thin-walled, because Ithe muscular coat of the intestine is usually absent in them ; they arerounded in shape, do not attain to large size, and are practically limitedto advanced life. In the urinarv bladder, other parts of the gastro-intestinal tract, the gall-bladder, the vermiform appendix, and Fallopiantubes, similar swellings have been described; indeed, it is safe to saythat they will be found if sought for in any of the hollow muscular-coated viscera. The cause in all is obscure, but in the colon as else-where, it is probable that chronic obstruction to the escape of thecontents (constipation) and weakening of the wall are the determiningfactors. The suggestion that they are due to traction from littlemasses of fat must be received with caution, for it is a curious fact thatmany pathological conditions of the colon-even cancer and tubercle-are associated with localised deposits of fat in the bowel wall. In theurinary bladder, where they have been known longest, they havealways been called sacculi, and this would appear to be the most suit-able name for them elsewhere. In their pathology, however, theyclosely resemble the diverticula of which the vermiform appendix maybe taken as a type. Like this, they may harbour faecal concretions,and inflammation in them leads to the same results. It is thereforepossible to find, as a consequence of sacculitis of the sigmoid.gangrenous perforation with peritonitis, ulceration, and perforationwith left iliac abscess, or inflammatory thickening and fibrosis closelyresembling a malignant growth of the affected bowel.

I am, Sir, yours faithfully,Newcastle-on-Tyne, Nov. 29th, 1909. RUTHERFORD MORISON.RUTHERFORD MORISON.

ANNUAL MEETING AT THE ROYALCOLLEGE OF SURGEONS OF

ENGLAND.10 U fJlUJ UJ THE LANCET

SIR,-In your report of this meeting an inaccuracy so

serious appears that I am sure you will correct it in yournext issue either by inserting a correcting paragraph or thisletter, as you may think the better thing to do. I refer tothe following : Dr. W. G. Dickinson asked the Presidentwho were "the body corporate " referred to in the annual

’eport of the College at page 9. Your report states that thePresident replied that "the body corporate" consisted of- he past, present, and future Fellows and Members. As Iwas present I can vouch that what the President actuallysaid was the body corporate consists of the past, present,and tuture Members of the College." This is the reply alsoreported in your medical and lay contemporaries. There isvital difference between your report of what the President

said and his real reply.-I am, Sir, yours faithfully,SIDNEY C. LAWRENCE, M.B., D.P.H., M.R.C.S.,

Honorary Secretary, Society of Members of theRoyal College of Surgeons of England.

Lower Edmonton, N., Dec. 7th, 1909.

SIDNEY C. LAWRENCE, M.B., D.P.H., M.R.C.S.,Honorary Secretary, Society of Members of the

Royal College of Surgeons of England.

THE HARD CASE OF THE LONDONSTUDENT.

To the Editior of THE LANCET .To the Editor of THE LANCET.SIR,--After reading your excellent articles on medical

education one feels that, indeed, the medical world is "outof joint." Main issues are so often missed, and as regardsthe question of "degrees for London students" the mainissue is usually passed over.The M.D. degree of most universities involves only a

medical training. The degree is considered academic becauseit is conferred by a university. The arts and science trainingrequired are practically the same as for a licence. No degreein arts is taken in most instances, and excepting for pre-liminary work the whole training is technically medical."There’s the rub." With similar conditions of curriculumand examination there is a difference in title and in namewhich leads to jealousy and confusion. I place our greatLondon medical schools on an equality with the medicaldepartments of most universities, and I hold that those ofus who took respectable positions in the class-work andexaminations of those schools, and also took our licences topractise, are in no sense the inferiors, either in training or posi-tion, to the graduates of medical departments of universities.That the examinations of some universities go beyond theordinary grade is true, and men holding those degrees arecredited with the position their work has gained, but that

, any invidious distinction should be made in title or other-wise between the graduates and diplomates of approximately

. equal standing is absurd and unreasonable. The questionstands thus. Is it just that London students who have

passed through the training and examinations of a medicalcollege equal in every respect to the constituent medical

colleges of most universities, who have also passed examina-; tions for qualifying diplomas recognised by the General

Medical Council as sufficient to ensure registration on equalterms, shall be allowed to suffer under a technical disability

- in the eye of the public ? It is not just I There can be noother answer.The remedy is not far to seek. All that is required is the

I will to remove the evident injustice, and a disposition toe sink small jealousies and petty self-seekings.

I am, Sir, yours faithfully,t Loughborough, Dec. 4th, 1909. J. B. PIKE.J. B. PIKE.

THE INFLUENCE OF MIND AS ATHERAPEUTIC AGENT

To the Editor of THE LANCET.SIR,-In his remarks on Dr. Morison’s views concerning

the influence of mind as a therapeutic agent Mr. J. FosterPalmer would seem to condemn hypnotism entirely. Thesentence, "when hypnotic suggestion takes the form of

inducing the patient to believe what sound reason tells himto be impossible," might be taken as an admission thatthis is not always the case, but other passages, in which

hypnotic suggestion is termed ° induced insanity," " criminaloffence," "the more execrable" because enfeebling thealready feeble-minded, leave no doubt that the condemnationis intended to be absolute.

I will not enter into doctrinal considerations, but it maybe pointed out that hypnotism does not always meanenfeeblement of will. A patient may, with the sane part ofhis mind, desire a healthy ideal, but may be kept, neverthe-less, in hopeless degradation by a morbid obsessive idea. Insuch a case-chronic alcoholism, for example-rational per-suasion, as we all know, may fail utterly, whereas the inter-mental influence of hypnotic suggestion may strengthen the

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mind against unhealthy impulse, and often cures such cases.definitely, twice in my experience in the course of fiveminutes. Such a result can scarcely be termed partingwith reason." " In Dr. Morison’s excellent letter there are,it is true, as in Mr. J. Foster Palmer’s, sentences whichread separately contradict one another, but taken as a wholethe meaning of the writer is quite clear. Rational persuasionis to be preferred, but for those in the portico of thelunatic asylum " any kind of make-believe is better than

ansanity. Delusive methods are, however, seldom necessary,for an intermediate plan which is neither simple rationalpersuasion nor make-believe deception is available. This isthe elimination of error and the credencive induction byhetero-influence of the right and the reasonable. But Icannot see what objection there can be to inhibitingabsolutely by hypnotic cambriolage the impulses of a hopelessinebriate, if he cannot be reseued from slavery by any othermeans I am, Sir, yours faithfully,

Paris, Dec. 5th, 1909. MORAL ORTHOPEDIST.MORAL ORTHOPÆDIST.

APPRENTICESHIP.To the Editor of THE LANCET.

SIR,—The discussion by the County Council of the reportof its education committee on the extent to which thEscholars at London’s elementary schools drift into unskilledlabour, coupled with the interest of Sir John Knill, thenew Lord Mayor of London, in the matter of apprenticeshippoints to a serious effort being made towards the organisa-tion of apprenticeship under Government auspices. As youhave given space to the debate at the London County CouncilI think you may be willing to publish a few words from onewho is interested in the movement as a practical worker.There is a risk lest what is being really aimed at, which, by’the way, has a large medical side, should be misunderstood.

The Lord Mayor seems to be in favour of a revival ofapprenticeship under old conditions, when apprentices ’’ livedin," but the public does not appreciate that by these wordsthe modern sense of the term ’’ living in " is not implied,under which adult shop employees are housed together onthe premises of the shop or in dormitories in neighbouringbuildings. The revival of the old apprenticeship systemwould make a lad a member of his master’s family,sharing the family life and meals. Surely a revival.of this system is impossible, and it would be a pity that.anyone should confuse a very modern movement towardstechnical education with impossible mediævalism. No

apprentice would in these days either consent to or beallowed to sleep under the shop counter or in any oddcorner of the premises. Decent sleeping accommodationwould have to be provided for him, and where the masterlived over his place of business sufficient space would as arule be unavailable, while where the master lived in a-suburb the whole principle of such ’ living in " would bealtered, if only because the expense to the apprentice oftravelling to and fro would not be compensated for by his"living in." In the olden days of apprenticeship, the lad,’being a veritable member of his master’s family, receivedthe same moral guardianship as the members of that family,’but this would not now be possible for numerous reasons, onebeing that the employer of labour often delegates his

responsibility towards his own children in this direction to ’,

- a schoolmaster. It is probably desirable that boys and- girls just leaving school should continue to live with their

parents; it is wrong that they should live anywhere wherethey are not under supervision.

Let us, then, leave "living in" out of the question..Apprenticeship in London in the future cannot as a rule beassociated with any such practice, but must be a systemunder which the boy or girl beginning business is placedduring working hours, with some arrangement about

premium, for a definite time with an employer. It has been

urged by some interested in this matter that trade schoolsare a better solution of the question how to increase theamount of skilled labour in this country than any attempt torevive apprenticeship, and the hygienic conditions underwhich children are taught in these schools are certainlysuperior to those existing in the average factory or workshop.The large factory run by a limited liability company,where no interest would, or could, be taken in individual

,apprentices, is not under consideration ; at such places the

hand is only taught one process and never learns a completetrade. The fact that general education is continued in thetrade schools, so many hours per week being given to it, isan important point in their favour. Here we have some-

thing to replace the interest in the general welfare of theapprentice that was manifested by the old-time masters. Iftrade schools could become a complete and full organisationI grant that the system would be ideal ; but expense alonemakes this impossible, and some form of apprenticeshipmust go hand-in-hand with trade schools. As an alternativeto the general education in trade schools we have eveningclasses, but they require cooperation on the part ofthe master, and also a great deal of care is calledfor from the parents, so that overwork may be guardedagainst. Also at these schools there is always a temptationto work at subjects connected with the apprentices’ tradeand not at general education. Mr. Cooper, speaking fromthe labour benches in the County Council debate on the

subject, urged that a larger supply of skilled labour willnot create the demand seems unfortunate for two reasons.First, the foreigner is often to be found in London inpositions of trust as the foreman or the skilled work-man performing the more highly-finished and difficultprocesses in a workshop, pointing apparently to the fact thatthere does not exist a sufficient supply of Englishmen to fillsuch posts. I do not know how far this is general, but twotrades occur to me where British workmen are found ininferior positions-viz., that of the optician and theladies’ tailor. Second, if the young skilled workman cannotfind work at home, surely he might seek it in many colonies.The ranks of unskilled labour may there be as overfull asthey are at home, but the master of his trade should surelyhave a better chance of finding a market. It is becauseso many of the unemployed become a medical charge onthe community that I address this letter to you.So many of the unemployed unfortunately becomesooner or later "unemployables," filling our infirmariesand hospitals and putting a heavy burden on the shouldersof the skilled and thrifty among the community. Theauthorities, those of the Poor-law and those of the charitableorganisations and hospitals alike, which deal with such

problems feel that every year it becomes of more importancefrom the public health point of view that a greater securityof return should be enjoyed by the wage-earning classes.The apprenticeship movement is towards a better equipment,mentally and morally, of the youth of this country, andmedical men might well give it their support and sympathy.Both properly run trade schools and properly organisedmachinery for apprenticing children on their leaving schoolare desirable from a public health point of view.

I am, Sir, yours faithfully,A WORKER ON THE APPRENTICESHIP AND SKILLED

Dec. 1st, 1909. EMPLOYMENT ASSOCIATION.

NURSING ASSOCIATIONS AND MIDWIVES.-At theannual meeting in London on Dec. lst of the Sussex CountyNursing Association Mr. A. G. R. Foulerton, medical officerof health of East Sussex, stated that instead of losing 10infants out of 100 in East Sussex last year they had lost 6 or7, and he attributed this low mortality to the good nursingof the maternity nurses from the association. Further, outof 1800 women of the working classes attended in confine-ment only 4 died, death being absolutely unpreventable in3 cases. These figures point to the good work of the

Nursing Association, and those boards of guardians who donot, as they are legally empowered, subscribe towards theassociation are to be urged to make a contribution. Boardsof guardians will probably find in the near future that itwill be far more ecomomieal to support these nursingassociations than be compelled to make provision for in-numerable maternity cases, for in April next, when the Mid-wives Act of 1902 comes fully into operation, no untrainedwomen will be permitted to practise. Dr. F. H. Champneys,chairman of the Midwives Board, who was present, said thegreat difficulty in the question of midwives was in the ruraldistricts, but of the 1408 successful candidates since Aprillast 33 per cent. intended practising in the rural districts.That showed, he added, a steady influx of the women theywanted, who were prepared to practise among the poor. Therewas no reason to fear a serious shortage until April next,but a redistribution might be necessary and should bepossible.