1322

THE LANCET.

LONDON: SATURDAY, MAY 25, 1895.

MR. BALFOUR ON THE MEDICAL PROFESSION.

THE authorities of the Royal Medical Benevolent Collegeare to be thanked for securing Mr. BALFOUR’S presidencyat the twenty-seventh festival dinner. It is becomingevident that the public, apart from political proclivities,looks to Mr. BALFOUR as to one of its foremost guides indeep matters of thought and feeling. In his speech at thedinner we get a glimpse into his estimate of medicine, itsclaims on the public regard, and its most essential functions. ’,Like Mr. GLADSTONE and Lord SALISBURY he has thoughtmuch on the subject and his conclusions are not uncom-

plimentary to the profession. In company with most ’,speakers he recognises the amount, the lavishness, of its ’,gratuitous or ill-paid work-the skill and the time given,often by its most meritorious members, to those who cannot

recompense them. And on this fact he founds his claim for the

greatest medical charity of our country, one that providesfor the widow or the orphan-pension or foundation scholar-ship-of those who in the very nature of the sphere or the cir-cumstances in which they worked, or of the time they had towork in, had not the opportunity to ’’ provide for their ownhouse." The work of the profession is done very much in

secret. What agonies undreamt of by the public does notthe hospital surgeon or physic an relieve ? And the generalpractitioner in a poor district is not one whit less beneficentas he carries his help and his counsel to the houses of the

poor in their extremities of suffering, and in doing so often

lays the foundation of his own disease. It would not be

unreasonable if the charities of such a profession were

generously subsidised by the wealthy members of the public.We will venture to hope that the f:1700 which were

announced at the dinner do not represent the full

response to Mr. BALFOUR’s appeal.Not less interesting to our readers than his argu-

ment for the generous consideration of the professionby the public is his estimate of our position from

a critical point of view. He thinks the debt of humanityto medicine, though large in the past, is increasing and"likely to increase in the future in a rapidly extendingratio, " and this because it is becoming more sure in

its methods and in the application of science to its art.

"Science and practice are every day more and more joininghands....... Medicine is becoming ;more and more the workof the scientific expert and less the work of the empiric ";and he anticipates not only an "incomparable insight into thenature and cause of disease," but an ability to command in afar larger measure than we do now "the remedies which maybe successfully applied." Such estimates by such a judgemay well please the profession. But they have their seriousside. They strike at all superficial and careless work, andshould stimulate every practitioner to regard with interest asbeing one to be met with skill guided by science each casehe is called to minister to. This is the true line of

success-the real way of victory over all pretenders-toget the "incomparable in sight" into the cause of each

disease we are called to treat, and in that light to deal

with it.

Mr. BALFOUR seems rather afraid that with all its new

lights the profession may come to aid longevity too much,especially if men are temperate. As he says, temperanceis a virtue which medicine may counsel, but cannot enforce.

Undoubt(dly the clear message of medicine to men is oneof temperance. The want of this virtue will in most cases

destroy the best constitution and defy the best surgeryand medicine alike. A friend of Mr. BALFOUR’S thinks

that by more perfect medicine the span of life may be

extended to 120 years. It may be so. An old estimate

(Ecclesiasticus) gave a man’s days as possibly 100 years,and twenty more would seem a slight improvement forover twenty centuries to effect. Mr. BALFOUR in the end

of his interesting address suggests that the mere pro-

longation of life is not one of the triumphs of medicine.He demands of medicine that it shall ease men of pain andthat it shall render the allotted life we have more available

for work and duty. Given this, he would relieve it of the

duty of prolonging a painful and useless life. There is E,

doubtful ring about this suggestion. It is very difficult to

dissociate the function of relieving pain from that of pro.

longing life. They are practically synonymous. But we

cannot admit that even where we cannot relieve painwe are one whit the less bound to preserve and pro-

long life. "This long disease my life" has been true ofmany others than POPE who have made great contributionsto the happiness of the world. A late physician who,

did more than most men of his order used to faythat he never had a day’s health in his life ; Jetfew men enjoyed life more or used it better. There is a

charm in life which we should expect Mr. BALFOUR to

recognise apart from conditions of perfect ease-" For who would lose,

Though full of pain,.this intellectual being-Those thoughts that wander through eternity ?"

Man is a creature of such possibilities that the prolongationof his life for even a few weeks or months may have great im-

portance, and although "the laws of the realm may punishChristian men with death for heinous and grievous offences

"

it is not yet recognised as part of a medical man’s duty thathe should take away that which he cannot give back.

THE oration by Mr. PEARCE GOULD on the Recent Evolu-tion of Surgery was more than a mere domestic event in the

history of the Medical Society of London. It was a state-

ment of the nature and significance of the recent develop-ment of surgery such as could only be made by an oratorwho had made some mark both as a teacher and a surgeon,The crowded and representative audience, composed of menin every branch of practice, showed that the subject was oneof absorbing interest, and the close and quiet attention

with which the address was listened to was the best proofthat the orator had succeeded in his object. Surgery is nolonger a mere matter of handiwork. It is an object-lessonin which the great facts of physiology, biology, and patho-logy find recognition. Mr. GOULD’s address will have

historical interest not only as the exposition of this change,but as tending to give the change great confirmation. Withinthe memory of middle-aged men the surgeon was little morethan a user with marvellous dexterity of knives and scissors

1323"THE RECENT EVOLUTION OF SURGERY."

and needles. But the results were not equal to the

manipulation. Not only so, the sphere of inter-

ference was very limited. Nearly everything beneath

the surface of the body was considered out of reach

and was relegated to the physician. Now the surgeonruns the physician very closely in respect of know-

ledge of the fundamental sciences which underlie all

successful practice and has that exquisite regard for thepeculiar properties of every organ and tissue which had

hitherto been credited mainly to the physician.In all recent expositions of surgery and its progress the

introduction of antiseptics has overshadowed all other

facts in prominence. Mr. GOULD last Monday night was

very successful in avoiding the use of this hackneyed phrase,but, all the same, this fact was the foundation of all

that he said, as will appear. His point was to show

that something has happened in the development of surgeryin the last twenty-five years more important than the

ordinary progress of any similar period or of any previouscentury, "or even millennium." Some may think the proposition extreme; but the steady way in which Mr. GOULDbuilt up stone after stone in its demonstration will leave no

doubt that in the main he was right. Progress was not astrong enough word for his purpose. Evolution was pre-ferred. The word in this sense and connexion is opento some criticism. It implies, to our thinking, some-

thing essentially progressive, continuous, and even. But

it is a part of Mr. GOULD’S contention that something hashappened in surgery out of the common, expanding andelevating it in every branch and department, and that thishas produced rapidly a change in the character of all thework done. This is not mere evolution. It is more like

revolution. It is, in fact, discovery. Of course, there is a

sense in which discovery is evolution ; but we do not applythat word to NEWTON’S discovery or even to DARWIN’S.A grand conception, a pregnant idea, may be regarded as partof a great progress of mental evolution, but the word itself israther applicable to great, continuous, equable processes innature affecting organised beings. This, however, is a

detail. The excellence of Mr. GOULD’s address consisted

in the wide view he took of the change that has come

over surgery and over the spirit in which it is prac-tised. His analysis of the elements of improvementwas as admirable as it was original. The removal of

the formerly admitted anatomical restrictions upon surgical ioperations ; the higher anxiety to preserve the physio-logical integrity of the organism; the essentially con-servative nature and tendency of the operations prac-tised under the new system ; a higher conception of

the nature of surgical operations, of the way in which

wounds are to be repaired, and of the personal respon-

sibility of the surgeon for avoiding disasters from his ownprocedures more terrible than the original disease ; the clear..apprehension that the causes of disease have to be treateddirectly; the introduction of what are practically physio-logical operations into surgery-these are the elementsof the great evolution or revolution which would makethe practice of any living surgeon unintelligible to

a surgeon who practised fifty years ago if he could

be suddenly brought back to witness the change. Theyare ideal changes which raise the spirit in which work is

done, the methods by which it is done, and the resultswhich follow.

Though Mr. GOULD said scarcely anything on Mondaynight of antisepticism, his tribute to Sir JOSEPH LISTER

was the feature of his address. He referred powerfully tothe incident of Sir JOSEPH LISTER’S paper read beforethe same society twelve years ago on the direct suture

of the fragments of a transverse fracture of the patella,and to the remark of a distinguished junior that fuch

a procedure was magnificent, but was not surgery! And

in his peroration he did not hesitate to place Sir JOSEPH

LISTER’S name in a line with HARVEY’S and with JOHN

HUNTER’S as the one which now shines with an unrivalled

splendour on the page of surgical history. This praiseis just, and it is not premature. Mr. GOULD was rightin emphasising the duty of doing honour to men to whomhonour is due while they are alive. Nor is the praiseless just because it comes from British lips. It will be

echoed from every civilised country. But it was well

spoken here. Foreigners will not think the less of us or ofhim for doing justice to Sir JOSEPH LISTER, to whom morethan to any other man we owe the elevation and the advance

of surgery, whose methods have introduced safety where

formerly all was full of risk, and have had an efEect on thecomfort of patients after operation which is only less

remarkable than the anasatheaia which deprives the operation itself of terror.

.

THE importance of the discovery of argon, a newlyidentified constituent of the atmosphere, by Lord RAYLEIGHand Professor RAMSAY is yet to be estimated. Alreadyit has opened up ramifications which have bewildered manyof our leading scientific men, some of whom have been

led into quite new fields of study of which argon must beregarded as the gate. First came the observation of the

eminent French chemist, M. BERTHELOT, that when argonwas submitted to the action of benzene vapour under

the influence of electrical discharge there was some in-

dication of a combination having taken place, so that not

a few began to think that argon-meaning inert-was nota well-chosen name. But the most interesting result of

M. BERTHELOT’S experiments was the fact that after sometime the silent discharge through this mixture became

gradually luminous, and the tube was lighted up in almostits entire extent at first with a violet tint with a reddish

rain of fire, changing gradually to a splendid green shadevisible even in full daylight and recalling in a most

striking way the brilliant spectacle afforded in the auroraborealis. Professor RAMSAY followed soon after with the

startling announcement that he had found that the gasevolved from a certain mineral (clèveite or uraninite) ontreatment with acid was argon and not nitrogen, as h. dall along been supposed, and that, further, a spectroscopicexamination of this gas revealed a bright and perfectlydefinite yellow line situated between the well-known sodiumlines, which left not the slightest doubt that an elementhitherto regarded to exist only in the sun (helium) had beenset free from a terrestrial mineral. This has since been fullyconfirmed, and helium has been added to the list of sim-

plicities-so far as we know them to be simplicities,-while

1324 THE PRESENT POSITION OF RECENT CHEMICAL DISCOVERIES.

many of its properties have since been ascertained. ProfessorCLEVE, however, from whom the mineral derives its name,was unable to confirm the presence of argon, althoughhe expressed no doubt as to the presence of helium. "What

makes me most curious," he wrote to Professor THORPE,"is that our helium gas was free from argon and that Mr.

RAMSAY’s did contain that most curious stuff. Is there anyrelation between argon and helium, and are we approach- iing a new epoch in chemistry " At once there arose a

mystery about "cleveite gas," which became still more

obscure when Professor NORMAN LOCKYER declared that he

had found no argon, but hydrogen. Thus apparently thesame cleveite had been tortured (to use Professor DEWAR’S

happy expression) by three independent investigators intogiving up to the first argon with helium, to the second heliumwith hydrogen, and to the third helium. Could cleveite be

the mystic philosopher’s stone which in its substance couldtransform one element into another, so that, accordingto the condition of experiment to which it was sub-

mitted, it gave up and presented to one argon, to

another helium, and to another hydrogen ? Or does it

- contain the primary stuff of which all elements must he

be composed in accordance with the celebrated hypothesis ofPROUST, or, later, of Professor CROOKES, and that on extrac-tion it assumed one of those forms known to us as hydrogen,helium, or argon ? The idea, however, that we were nearingthe transmutation or transformation of elements vanished

rapidly into thin air when Professor RAMSAY announced afew days ago that the gas he originally obtained was con-taminated with atmospheric argon, but that the gas accom-panying helium was none other than hydrogen with

traces of nitrogen, so that it transpires that what was

originally regarded as nitrogen evolved from clèveite and

then argon was after all helium with hydrogen and

traces of nitrogen. That, at any rate, is the latest re-

presentation of the composition of cleveite gas. It is

all the more remarkable that in searching for what

Professor RAMSAY thought would most likely turn out to be

argon he stumbled upon another element altogether-thelong-missing helium. For the present this discovery must be

regarded as the most important outcome of the splendid andlaborious investigations which led Lord RAYLEIGH and

Professor RAMSAY to announce last year for the first time

the existence of this constituent in the atmosphere. The

possibility of further discovery does not, however, stop here.Professor NORMAN LOCKYER, for instance, who obtained

the gas from the mineral by heating it in vacuo-a method

he uses for the extraction of gases from meteoric stones,-isled to suggest that the gas is one of complex origin,and spectroscopic analyses show distinctly that several linesin cleveite gas are closely related to the solar and stellarphenomena. "We appear to be in the presence of the vera

canso," he writes, I I not of two or of three but of manylines which so far have been classed as unknown’ bystudents both of solar and stellar chemistry ; and if this be i

,confirmed we are evidently in the presence of a new order ofgases of the highest importance to celestial chemistry,though perhaps they may be of small practical value to

,chemists, because their compounds and associated elements.are, for the most part, hidden deep in the earth’s interior."

It will be readily realised that the interest created by

these observations is intense, and we can imagine the

scientific thinker drawing a deep breath in almost feverishexpectancy that before very long a portion, at any

rate, of the veil which keeps many of the cosmic mysteriesfrom our view will be drawn aside. Then we shall indeed

attach some importance to Lord RAYLEIGH’S and Professor

RAMSAY’S joint discovery.

THERE was a time, not very remote from the present,when complaints were frequently made of the tardiness

with which the national returns of birth and death were

issued from the General Register Office-the more importantof these returns, up to a recent date, having been rarelyavailable to the public until nearly two years after the

expiration of the period to which they severally related.

Having regard to the vastly greater interest which nowadaysattaches to the official mortality returns of Somerset Housein consequence of their direct bearing on the question oflocal sanitary administration, we are glad to note that thepublication of the Registrar- General’s quarterly and annualreports and returns has of late been considerably expedited;and as this has been accomplished without, we believe,any addition to the cfficial staff we regard the event

as highly creditable to the Statistical Department. For it

is obvious that so far from the work becoming lighteras time goes on the number of facts to be dealt with in

successive reports increases year by year, almost pari passuwith the growth of the population. The circumstance which

has suggested the above remarks is the publication withinthe last few days of the Registrar-General’s Annual Summaryfor 1894, which gives useful information respecting the

mortality that prevailed amongst a considerable portion ofthe population of England during the fifty-two weeks of thatyear.

Originally the annual summaries had exclusive reference toLondon and a few of the larger provincial towns. The

present summary, however, relates to 100 of the most

important urban communities of England and Wales,including, of course, the metropolis ; and with respectto many of these areas the information given is

more extended, and for local sanitary purposes far more

serviceable, than any that has hitherto been accessible

In addition to the thirty-three great towns included in

Table I., full mortality statistics for which have been pub-lished in the periodical returns for the last few years, corre-sponding information is now for the first time given inTables V. and VI. relating to sixty-seven other English andWelsh towns, which, although of less size than the thirty-three chief towns before referred to, are, nevertheless, of

considerable importance and contain amongst them an aggre-gate population of more than three and a half millions.

Many of these towns are either sea-side or inland health

resorts, and consequently an authoritative statement con-cerning their death-rate, and especially their mortality frontinfectious disease, cannot be otherwise than interesting andserviceable to intending visitors.Another new feature in the recently issued summary which

is worthy of attention is the introduction into Tables H. and I,of a column giving the distribution of the corrected mortalityfrom phthisis in each of the five groups of sanitary areas into

1325NEW FEATURES IN THE REGISTRAR GENERAL’S RETURNS.

- which the metropolis is divided for statistical purposes. In

Table H. the deaths from phthisis are given in the severalsanitary areas of London, but in view of the uncertainty.attaching to estimates of population for areas of this kindwe think that the Registrar-General has acted wisely in

abstaining from the publication of rates of mortality for

populations smaller than the five groups of sanitary areaswhich are comprised in Registration London. When the

census of next year shall have been completed we shall

hope to see a table published in due course similar to

the one now given (Table I.), but dealing with individual

sanitary areas, and giving, on the secure basis of the

.census figures, the rates of mortality not only for

phthisis, but for the other diseases also which are at

present included in the table referred to. Another table,which we notice for the first time in the present annual

summary, is the one marked C. on page viii., which showsthe deaths from influenza registered in each of the metro-politan sanitary areas in the five several years 1890 to 1894,practically the period covered by the epidemic, which has,even now scarcely come to an end. Yet another new table

(E.) will be found at the foot of page x., which gives theadmissions and deaths at the Metropolitan Asylums BoardHospitals, the Highgate Small-pox Hospital, and the LondonFever Hospital of persons suffering from small-pox, scarletfever, diphtheria, and enteric fever respectively. The

admissions and deaths are given for the ten years 1885 to1894, and are extremely interesting as showing a rapidly’increasing tendency on the part of the public to avail

themselves of public hospitals for the treatment and isola-tion of the infectious sick. It is necessary, however, to

utter a word of warning against the acceptance of the figuresin this table as being in any degree an accurate measure

of the amount of infectious sickness actually present at

any given period in the metropolis. It is well known that

whenever such a disease as, for instance, scarlet fever

becomes seriously epidemic in London the hospitals speedilybecome filled with cases of that disease, and thus no available

space remains for the accommodation of other and

not less infectious forms of fever - diphtheria, for

example, which disease, as is pointed out in another

part of this interesting summary, has been steadilymaking headway in London for several years past. As

far as may be judged by the mortality statistics of the

100 great towns, the health of England and Wales during the

year 1894 was, on the whole, eminently satisfactory. For

instance, the thirty-three principal towns, which contain anaggregate population of more than 10,000,000, showed a

death-rate of 18’1 per 1000 only, against an average rate forthe ten previous years of 21’3. London was subject to a

mortality not exceeding 17’8 per 1000, or 2’6 per 1000 below

the average; and many of the other great towns showed adecline even greater than these. Turning to the figures for thesixty-seven smaller towns, now published for the first time,we are struck by the extreme lowness of some of the rates.The 3,500,000 people inhabiting these towns died in 1894at the average rate of 16’0 per 1000. Amongst these townsnot one bad a rate exceeding 22’1 per 1000, whilst the rateswere as low as 9-5 per 1000 in Hornsey, 10’0 in Bourne-

mouth, and 10’3 in Eastbourne.

Annotations."Ne quid nimis."

THE MEETING OF THE GENERAL MEDICALCOUNCIL.

THOUGH we are writing before the issue of the programmeof business at the approaching meeting, we cannot be wrongin assuming that the subjects to be discussed will be of variedand considerable interest. One change in the personnel wbe felt as well as seen. Sir John Simon will be conspicuousby his absence. It must, however, be admitted that hissuccessor will be a real acquisition to the Council. Consider-

ing the importance of questions of State medicine and themultiplication of medical officers of health, it would havebeen unsatisfactory had any less authoritative exponent ofthe State interests in sanitation than Dr. Thorne Thornehimself been appointed to succeed Sir John Simon. Someother day when a Crown vacancy occurs the State maygenerously give it to a general practitioner, as it has

done before in the case of Scotland, but all must allow

that Sir John Simon’s successor is well chosen, the moreso as a chief feature of the business will be the discussionof reports on Diplomas in State Medicine. It is expectedalso that a general report on the recent inspections of exami-nations will be received from the Examination Committee.It would be sanguine to expect that sundry cases of allegedmisconduct will not occupy a considerable part of the time ofthe Council. The subjects of the Midwives Registration Billand of the issue of certificates to midwives by the ObstetricalSociety and other bodies will necessarily come before theCouncil. At the last meeting, as the minutes of 1894 show,a report was expected from the Executive Committee on theproposed amendments of the Medical Act, but it was not forth-coming. Doubtless it will appear next week. The fate andfuture of the Apothecaries’ Society of Dublin will have to beconsidered and determined by the Council. Perhaps the mostimportant question of all is the fixing of final arrangementsfor the issue of a new edition of the Pharmacopoeia, aboutwhich considerable difference of opinion exists. Ourreaders may like to know that the Council will commence its

meeting on Tuesday next at two o’clock with an address bythe President, Sir Richard Quain.

A CASE OF ALLEGED PREMATURE BURIAL.

UNDER the sensational heading " Le Cauchemar " we readin Le Petit Journal the most recent case of alleged pre-mature burial. It is copied from Greek newspapers, andalleges that the Italian Consul at Mersina, in Turkey inAsia, the name being given, died the week before last, theword "mort" being in italics. The funeral took place withmuch pomp and ceremony, all the foreign consuls and localauthorities being present ; the burial took place at theRoman Catholic cemetery of the town. That same eveningone of the keepers of the cemetery, so runs the story, heardcries coming from the vault just closed. Seized with terror,he ran to forewarn the family. They hastened to the

cemetery, and the coffin was opened. Then follows a har-

rowing description of what was seen; which need not be

repeated since the appearances were such as would naturallyresult from decomposition, and to the eyes of terrified lay-men accepting implicitly the story of the alleged cries wouldpresent all the supposed phenomena of premature burialNo mention is made of the nature of the last illness or ofthe cause of death, nor are we told what followed upon thealleged frightful discovery. As the deceased was a RomanCatholic it may be assumed that he had the servicesof a priest up to the last, and it is impossible to believe