62

THE LANCET.

LONDON: SATURDAY, JULY 14, 1883.

THE COLLEGE ELECTION.-THE MEDICAL BILL.

WHATEVER of surprise and unexpectedness there mayhave been in the result of the voting at the election at theRoyal College of Surgeons last week, its substantial justicecannot fairly be impugned. Though the antecedent im-probabilities were very great that two surgeons belongingto the same hospital would be elected, yet it may now beconceded that neither Mr. SYDNEY JONES nor Sir WILLIAM

MAC CORMAC was without considerable claims. Mr. JONES

enjoys a high reputation as a practical surgeon, not only inhis own school, but throughout the profession generally;while Sir WILLIAM MAC CORMAC, by his vigorous vindi-cation on Lord MORLEY’S Committee of the Army MedicalDepartment in the recent Egyptian campaign, had estab-lished some right to the favourable consideration of the

Fellows. It would probably be correct to say that Mr.

SYDNEY JONES was elected chiefly through the St. Thomas’sinterest; whereas the support given to Sir WILLIAM

MACCORMAC, though numerically weaker, was of a moregeneral character. Mr. COOPER FORSTER’s re-election wasin accord with general anticipation.The most remarkable event, however, was the utter failure

that attended the two provincial candidates. Notwithstand.

ing the fact that the number of provincial Fellows whorecorded their votes was unusually large, the votes polledby Mr. OLIVER PEMBERTON and Mr. REGINALD HARRISONwere few. Considering the protestations and excitementpreceding the election, it might have been expected that atleast one of these would have been elected, and that by aconsiderable majority.While the result of the election may be allowed to pass

unchallenged, it would not be right to grant the same graceto the mode in which the candidature and the actual pollingwere conducted. Previous to the day of election an orga-nised system of canvassing was carried on, not only by someof the candidates themselves, but also by means of regularCommittees. All the usual electioneering tactics were adoptedto attract notice and to catch votes, though it is some satis-faction to find that some of the more impudent attemptsrecoiled injuriously upon the perpetrators. A seat in the

Council of the College of Surgeons should be an honourabledistinction conferred by the favour of the Fellows, not un-blushingly solicited by pretentious personal appeals. The

prospect is a melancholy one if a candidate cannot hope tobe successful at the College elections unless he blows his

own trumpet, and calls upon his friends to join in the chorus.There are some who believe that both Mr. LAWSON and

Mr. DURHAM might have taken higher places had theybeen less scrupulous about soliciting support.

One circumstance appertaining to the recent election

needs only to be mentioned in order to be condemned

by all right-minded men. It will be remembered that

at the last meeting of the Council, on the motion ofMr. CADGE, it was resolved to appoint a committee toconsider the expediency of allowing the Fellows to vote

at the election of the Council either in person or by votingpaper. Concurrently with this motion, but in reality quiteindependent of it, a section of the Fellows residing in theprovinces endeavoured to ascertain by letter the views ofthe various candidates on exclusive personal voting. Mostof the candidates returned answers favouring an alterationin the Charter to allow of voting by voting-papers, one ortwo merely acknowledged the receipt of the letter, whileone wrote and afterwards published an answer which wasdistinguished by smartness rather than by good taste. It is

a notorious fact that many of those who do not wish to see

any change in the existing arrangements allowed theirvotes to be influenced by the answers that had been re-turned. Some Fellows, while resenting the action of theirprovincial brethren in attempting to find out the opinionsof the candidates on compulsory personal voting, did notthemselves scruple to make personal inquiries of the candi.dates, and to bestow their votes in accordance with thetenour of the answers they managed to extort. This is surelya species of intolerance unworthy of a constituency com.posed of presumably honourable and enlightened men.

- --

IT is very gratifying to find that the Government

adheres to its determination to proceed with the MedicalBill. Any other course would have been unworthy ofit, considering the suspense in which the present situa.

tion keeps two thousand medical students and all thebodies concerned in medical education and in the testingof it; and it would have been inconsistent with that heartyappreciation of the Bill expressed by Mr. GLADSTONE afew weeks ago. We are well aware that the session is far

advanced. That is to be regretted, but is not a reasonfor not doing the session’s work before the session is over.All parties that have at heart the credit of Parliament as aninstrument for business should make an effort, and evena sacrifice, to carry Bills reasonably within the approvalof the House. It is not only medical education and themedical profession which would suffer by the miscarriage ofthe Government Bill, but the House itself would suffer inreputation, and be judged as very inefficient in leaving undonewhat everybody sees ought to be done, and what has beenin hand for eleven or twelve years. Such resolution

on the part of the Government throws a double responsi.bility on all persons interested in medical reform, and, letus add, on all persons opposed to it. There are, of course,

persons who would not be sorry to see the Medical Bill

miscarry. The established order of things, however unjustinefficient, or even scandalous it may be, is precious to thosewho enjoy privileges under it, and seems so perfect to themthat any disturbance of it is contemplated with horror.Nineteen examining bodies, bogus fellowships, unequal ex.aminations, ineffective medical schools, are all more tolerableto such minds than a measure which would reform them all,or whose tendency would be to do so. Then there are others

who are real medical reformers, but who cannot accept anyMedical Bill which does not come up to their own idealIf Parliament had twice the time for Medical Bills which ithas, such reformers would be reasonable in asking for a dozenamendments of the existing measure. But to battle for an

ideal is to risk the Bill; and we appeal confidently to allreformers to content themselves with reducing amendmeJ1tØ

63"OVERWORK" IN RELATION TO EDUCATION.

to a minimum, and, if they cannot get three-thirds of all they it will no longer even replace normal waste. The stress of thewant, to be contented with two-thirds. The other third may work falls onthe nerve-centres, which of course are the sourcesbe added easily another time. Let us take the one long of energy, but it seems probable that the terminal plates instep forward which this Bill enables us to take. It provides the muscular tissue, which are probably reservoirs of nerve-an examination-a one portal-in each division of the king- force kept charged-as Leyden jars may be charged withdom for all students; an examination guaranteed by all the electricity-for the purpose of local or reflex activities, maycorporations and universities in that division, and sanctioned themselves be specially exhausted and rendered incapable ofby the Medical and the Privy Councils. It concedes the prin- normal action, so that " cramps," stiffness-which is rigor,ciple of direct representation. It improves the Medical Council doubtless due to commencing coagulation of the myosin,-and elevates its functions by making them more authoritative and local pain or tenderness, often accompanied by fibrillarand responsible. It increases the sanctity of medical titles. pains and twitchings, due to local excitations, will ensue. AtA Bill that contains all these points is worth having, and we the same time the nervous system of the muscular appa-urge upon all our readers to induce their representatives to ratus being exhausted, the vaso-motor function is impaired,discourage all opposition to it, and to give it every support. the arterioles of the part affected lose their tone, and the

—————————— flow of blood through the region is retarded in 8peed,A GREAT deal has been said and written of late on the accumulation takes place, and what may be called atonic

subject of "overwork," more particularly in connexion with or passive hypersemia occurs, followed, it may be, by theeducation. It is time that this question received the full phenomenaof incipient inflammation; oriftherebenotenough-elucidation it requires. It is natural that such a term as of energy for that active state, then passive congestion, tran."overwork" should come into use, and that it should be sudation, swelling, and oedema will supervene. This is a hastypopularly applied to all forms or classes of injury sustained and very general summary of what takes place, or may occur,by the organ of mind in the course of exercise, whether in in muscular tissue, when it is " overworked." " Probably anresult of excess or misdirection of activity; but it must be analogous state of affairs supervenes in the case of nerve-

obvious to everyoie possessed of even the most rudimentary tissue, and notably of the brain, when unduly exercised.-acquaintance with physiology that the indiscriminate use There is, however, this essential difference between brain

made of this term is erroneous and misleading, and that the and muscle-namely, that inasmuch as the former is the

very hypothesis of overmork is in itself open to serious more delicately organised, and in a sense the most im-

<question, and what seem to be grave objections. portant-albeit it seems likely that nerve-tissue may beLet us recall t3 recollection for a moment what takes developed while muscular cannot be -it is specially

place in the case of muscular tissue under ordinary conditions protected, so that before " overwork’’ does serious mis.

-3f exercise, when intentionally developed by exercise, and chief in the case of nerve-tissue, there are nearly alwayswhen overstrained by excessive exertion, or, in other words, very distinct indications that the limits of healthy"overworked." Moderate exercise, as we know, simply activity have been reached. Under only moderate exer-consumes the force generated, or, in more technical language, cise nerve-tissue does not, as a rule, develop rapidly, norconverts potential into kinetic energy. There is just as much does it accumulate strength-that is, force held in reservematerial recuperation as will suffice to replace the elements and available for action. If the brain is to grow-thatutilised. Pushed a little beyond this, as in" training " judi- is to say, grow complex structurally -it must feed

piously conducted, muscular tissue is first incited to a gradual freely, consuming more than sufficient to replace its

increase in the amount of work it performs, with the effact of waste. If it is to feed, it must work. There is no

stimulating the recuperative faculty to a little more than way of stimulating the structural growth of brain ex-

merely compensatory energy, so that there is enough feeding cept by intellectual exercise. This is a point of funda-to suffice for growta as well as restitution, and the muscle mental importance, and it is of cardinal moment in

increases in bulk. This is not, as we know, due to any regard to that form of development by training whichaugmentation in the number of the elements composing the we call education. " So true, so inexorable, is this law,tissue, but to their increased development. They are not that not even general stimulation by work will suffice.more numerous, but they are larger. In point of fact, the If any special faculty of what we call " mind "-that is,fibres attain greater bulk in consequence of the increased brain function-is to be cultivated, it must be called out bystimulation and the larger amount of food assimilated special training-namely, by work of the special nature it isby the tissue, the supply of nutrient fluid, i.e., blood, desired to elicit. For example, there is no reason to

being augmented quite as much by the local demand suppose the faculty of learning languages can be developedfor food as by any other condition which may be sup- by exercise in mathematics, or the converse. This is

posed to determine a special flow of blood to the part. If a matter not sufficiently well recognised. A " strongmuscular exercise be increased too rapidly, faster than the mind" is a well-grown brain, and "bias of mind" israte of growth of the tissue, or if it be increased after the a brain with some one or more of its parts speciallytissue has attained the full limits of a normal growth- developed. Of course heredity has much to do with thewhich growth, it will be remembered, is simply com- question of capability of development, because the youngpensatory to the work done, as in hypertrophy of the left animal is produced " in the likeness" of its parent ; but soventricle of the hert,&mdash;there will be exhaustion : that is to far as we, as educators, are concerned, our training must be

say, an uuc,3mpens3.tecl consumption of tissue and, if the work special if we desire to get special results. In the pro-e farther increased, exhaustion may proceed so far as to en- cess of brain-growth, or, more accurately speaking, of brain-able the faculty of recuperation, itself, to such an extent that development, the elements of which the organ is composed

64 THE ABSORPTION OF FAT IN THE SMALL INTESTINE.

are exposed to precisely the same risks and contingen- channels left between these columnar cells; and variouscies as the elements of muscular tissue under varying modes of preparation have been appealed to as affording thedegrees of pressure by work, and, mutatis mutandis, the means of settling the question. ZA W ARYKIN, the well.

physiological, running into pathological, effects of pro- known professor of physiology in St. Petersburg, has justgressive increase of work are similar to those we have advanced another view in the last part of PFLUER’s 4 7’CitiV,attempted to recall. The faculty of recuperation is in which he supports by strong evidence, to the effect that thedanger of being itself exhausted, and depression of nerve lymph cells of the adenoid substance of the villi are theforce and atonic congestion supervene. A matter of active agents in taking up the fat molecules from the intes-moment to remember is that although the brain is struc- tine and transmitting them to the lacteals. In his experi-turally a packing together of centres, with afferent, efferent, ments he has employed dogs, rabbits, and white rats, theand inter-communicating nerve-fibres, it is itself supplied plan adopted being to remove the intestines a few hourswith nerves, and subject to precisely the same conditions after a meal, and to treat them with osmic acid, and then toof coarse disturbance as other organs. Sometimes we forget act upon them with picrocarmin, remove the water withthis fact, as at others we forget, not so much that it is an alcohol, render transparent with clove oil, and finally mountorgan, as that it is composed of nervous tissue. in Canada balsam. In preparations thus made he statesThe conclusions we deduce from these facts are as follows : that lymph cells charged with fat may be seen in the layer

" Overwork," properly so called, is not so likely to occur, or of columnar epithelial cells, in the adenoid substance of theif it occur to do mischief, as irregular or disorderly activity. villi, and in other layers of the intestinal wall. OrdinaryIf there be not sufficient time for recuperation in the course lymph cells thus treated exhibit nearly homogeneous proto-of work, exhaustion must take place. If the work done be plasm, which is of a greenish colour; but those that are im-of such a nature as to put an undue strain on any one faculty, pregnated with fat present a mist of black molecules, whichharm may be done, although the brain as a whole may not are not always evenly distributed through the mass, andbe severely taxed. If the supply of brain-food be insufficient cannot therefore be mistaken for the ordinary granulationsto enable the recuperative faculty to compensate by food for of the protoplasm. The fat-containing lymph cells may beconsumption in use, there must be exhaustion. If work be found in all zones of the columnar epithelium from theexacted when any indication of exhaustion is present, it is basal border to the subepithelial layer of endothelium,impossible that injury shall not be inflicted. It follows that and they may even be seen to project beyond the basaleducators have especial need of care to avoid engaging the striated border. The form of these cells vaiies consider-

brains of their pupils in work for more than very short ably, suggesting that they are performing lively amoeboidperiods, and to provide intervals during which there may be movements when suddenly attacked and rendered immobilerest of the centres specially taxed. Much may be done by by the osmic acid. In some instances they present longchanging the kind of work frequently. We are of opinion processes, usually directed towards the basal border, andthat no growing child should be kept longer than half or at often containing fat molecules. The presence of such a longmost three-quarters of an hour at one task, or even the same process, extending from a lymph cell lying near the attacheddescription of work. Again, the great centres of relation extremity of the columnar cells to the basal border of theshould not be overtaxed. Vision, hearing, the speech centre, epithelium, and charged with fat molecules, would explainand the centre specially concerned with written language, the views of those who consider that the fat molecules enter

whether in writing or reading, should not be wearied. Brain the intestinal wall between the columnar cells. ZAWARYKIN

weariness is the first indication of exhaustion. The faculty of is of opinion that his preparations tend to show that there"attention" is perhaps one of the most easily vulnerable of is a constant movement in two directions of the lymphall the parts or properties of brain-function. It is the faculty .corpuscles, those that are destitute of fat pressing towardswhich most readily becomes permanently enfeebled, and when the free surface of the mucous membrane and of the villi,weakened entails most trouble in adult life. In children it whilst others charged with fat are moving in the oppositeis difficult to catch and fix the attention. No effort should direction. The further transposition of the fat molecules is,be spared to secure this fixity of thought; but in order to he believes, in part into the central cavity of the villi, andavoid weakening the power of " thinking"-as distinguished in part along the adenoid tissue of the rest of the intestine.

from " thought-drifting"&mdash;the teacher should not strive, or In both cases, however, they soon enter the plexiform chyledesire, to hold the attention by any effort on his part longer vessels, which are situated at the base of the follicles ofthan it is voluntarily given by the child. The slightest in- Lieberkuhn. A point of importance which he has noted isdication of exhaustion should at once be met by a change of that the white corpuscles contained in the blood of the veinstask. If these hints, general as they are, can be reduced to and arteries are also charged with fat molecules, but he. is

practice, we think there is little fear of " overwork" or harm not prepared to state precisely how they obtain their fat.from brain activity. Desultory and insufficient work is more The follicles of Peyer’s patches appear to be especiallyto be feared by far than " overwork," because the brain, active in effecting the resorption of fat, as may be well seenlike every other part of the organism, grows as it feeds, in the case of rabbits. The fat may be seen in larger orand it can only feed as it works, smaller masses, composed of molecules and larger particles0 in the follicle itself, occupying both its peripheral and its

IT has long been a disputed question whether the fine more central part. The cells are particularly large in thearticles of fat, which it is admitted on all hands are ab- portion of the intestinal coat which lies over a Peyer’s patchsorbed from the small intestine, enter the lacteals through the leucocytes charged with fat here assume an almostthe columnar cells which cover the villi or through minute colossal size, sometimes lying in rows parallel to the long

65THE PROFESSORSHIP OF PATHOLOGY AT CAMBRIDGE.

diameter of the columnar cells, in others forming nests.The memoir is accompanied by some well-executed draw-ings by RAjEWSKY, which render the descriptions given byZAWAEYKIN very intelligible.

Annotations.&deg;‘ Ne quid nimis."

THE PROFESSORSHIP OF PATHOLOGY ATCAMBRIDGE.

BY the recent statutes of the University of Cambridge aProfessorship of Pathology was instituted, with a stipend of;E800 a year, irrespective of fees. The professor is not to beallowed to undertake the private practice of medicine or

su;gery, and he is to be appointed as soon as sufficient fundsfor the purpose can be conveniently provided from the com-mon University fund or from other sources. The GeneralBoard of Studies, with whom, under the new statutes, theinitiative rests, in their report upon the studies and require-ments of the University, lately issued, have expressed theopinion that the appointment of the professor should takeplace about Lady Day next. The Board, by whom theappointment will be made, has been already constituted, andconsists of the Vice-Chancellor, Professors Paget, Humphry,Latham, Michael Foster, Sir James Paget, Dr. Gaskell,Dr. J. F. Payne, and Professor J. Burdon Sanderson. Thereis at present no special laboratory for the professor, but thatwill no doubt ere long be provided. The professorship, likemost of the other Cambridge professorships, is open to all

persons, whether members of the University or not; andthere can be little doubt that a position highly desirablein several respects will have many aspirants. Thoughdebarred from private practice, the professor will be able tohold a hospital appointment; and a connexion with Adden-brooke’s Hospital would greatly increase his opportunities ofusefulness, and tend to give a practical turn to his investi-gations and to his teaching.

THE GOVERNMENT AND THE CONTAGIOUSDISEASES ACTS.

ON the 5th inst., the Marquis of Hartington, Sir Wm.Harcourt, and Sir A. Hayter brought in the GovernmentBill, providing for the detention in certain hospitals, certifiedby the Admiralty or the Secretary of State for War, of

persons affected with venereal disease, including gonorrhcea.It also repeals the Contagious Diseases Acts, 1866 to 1869.The second reading was down for the llth inst., but thepress of other business prevented its being brought forward.We regret this the more as Captain Price, the member forDevonport, had given notice that it was not expedient torepeal Acts which had proved of great value to the healthand morality of the public; and in this way the questionmight have been to some extent rediscussed. The Govern-ment measure-Detention in Hospitals Act, 1883-is so

crude and ill-considered, and is such a lame makeshift forthe former Acts, that we can scarcely believe that it isintended for serious legislation. Compulsory examinationhas disappeared in accordance with Mr. Stansfeld’s resolu-tion, and in its place we find that any woman who hasvoluntarily come into a certified hospital for cure can bedetained until the chief medical officer certifies that she is ina fit condition to be discharged. A voluntary patient canthus be compulsorily detained at the discretion of the chiefmedical officer. Do the authorities believe that the patientwill, under these circumstances, apply for admission beforeshe is so ill that she can no longer pursue her avocation ? Cananyone possibly estimate the amount of venereal disease

that will be scattered abroad if such an unfortunate enact-ment be legalised? Compulsory detention is absolutelyimpossible when patients are asked to come voluntarily to ahospital. If a patient voluntarily presents herself at ahospital she must be free to leave whenever she choose?.Another clause, which will be viewed with considerableastonishment by both magistrates and doctors, provides thata woman who considers herself entitled to be discharged,but is detained by the doctor, shall have a right of appeal toa justice, who will order her discharge if he is satisfied, uponreasonable evidence, that she is free from a contagiousdisease. If the Contagious Diseases Acts are to be repealed,let them be repealed in toto, and the results will, in ouropinion, lead in a very few years to their being re-imposedand extended. No one conversant with venereal diseases,and their symptoms and spread, can seriously entertain thepropositions of the Government. We cannot believe thatthere will be any real endeavour to pass them, and we canhardly understand authorities who doubt their efficiencybeing responsible for their publication.

THE PROGRESS OF CHOLERA.

SINCE the beginning of the fourth week in June, whencholera was first announced to be prevalent at Damietta,the disease rapidly acquired epidemic proportions both inthat town, at Mansourah, and at Samanoud, besides ap-pearing either continuously but to a less extent in othertowns, such as Cherbine, or, agan, in isolated groups or insingle sporadic attacks at other places. Damietta hashitherto borne the brunt of the epidemic, and some 15,000deaths have occurred from cholera in that one town. Nearly400 deaths have taken place in Mansourah, where the diseaseis now on the increase, whereas at Damietta some con.siderable diminution in the daily number of fatal cases hasat last occurred. So far the disease has been entirelylimited to the Delta of the Nile, and, with the exception ofan outbreak at Menzaleh, it has confined itself to townssituated along the lines of railway ; in other words, its

operations have been almost exclusively manifested alongthe main channels of human intercourse. Quarantinemeasures have been adopted in most European countries;but our Government have wisely decided to trust to thesystem of dealing with the sick and with infected things,and to leave the healthy at liberty. The effects of quarantine,

. as rigidly carried out, are already manifest in all their: cruelty at Mansourah, where the suspension of all intercourse

with the outside world prevents any food supplies from beingtaken in, and so this town, with its population of 16,000

i souls, is hemmed in by bayonets to contract cholera or dieof starvation. But whilst discarding this barbarous and

antiquated system, our Government has decided to take all) such precautions as are necessary for the protection of thist countrv. The present order relating to the importation of

cholera and similar foreign diseases is to be strengthenedand re-issued. ADepartmental Committee is to be appointedto sit in London under the orders of the President of theLocal Government Board, and a physician connected withthe India Office is to proceed to Egypt with a view of main-taining efficient relations with the home Government. OurPort Sanitary Authorities have had full warning as to theirresponsibilities. The distance between Egypt and our

shores will go far to prevent any unexpected occurrences ofcholera in ships not already obviously infected at the timeof then arrival, and we may fairly hope that even if cholera

! should be imported the arrangements which are now, or will, shcrtly be, in operation in our several port districts will

amply suffice for such work of isolation and disinfection. as will be necessary to prevent further extension of the: disease,