395

THE LANCET.

LONDON: SATURDAY, MARCH 11, 1876.

MR. HARDY’S SCHEME.

M. GATHORNE HARDY has laid the official axe to the

roots of one departmental tree, and no mistake, for hisschene for reorganising the Medical Department is, on theface of it, a very bold and revolutionary measure. We donot yt know the details of his plan, but there can be noroom ’,or doubt as to the principles on which it will be based.To be6"in with, the War Minister, on Thursday night, maybe said to have dug the official grave in which the presentdepartment, with its traditions, is to be interred. The lines

on which it has been constructed are to be swept away. To

compare great things with small, the existing service, likethe Irish Church, has come to be regarded as representingan effete system, and, like the barren fig-tree of the parable,it is to be cut down in order that it may no longer cumberthe ground. But this time the official axe is wielded by a

Tory Minister, and not by Mr. GLADSTONE, who has retiredto exercise his skill as a woodman in private life. From the

general tenor of the numerous communications that havereached us, the War Minister’s utterances seem to have

given rise to a deep sense of disappointment among themembers of the department - that much is clear. Mr.

HARDY was unusually emphatic in the declaration of hisintentions; he intimated very clearly and distinctly thatthey were the result of long and deliberate consideration,and we may, therefore, regard them as final, as far as he isconcerned. The experiment about to be tried is of the most

radical character, and should it succeed, there cannot be a

doubt, we imagine, that the same principles will be ex-

tended to other, and possibly to all, of the public medicalservices. The prominent points on which Mr. HARDY

dwelt were-(1) The old regimental, as compared with the Igeneral or departmental, system of medical organisation.(2) The scheme for surmounting the two great difficultieswith which the Government and the Medical Service have tocontend-the former with the want of candidates, and thelatter with the want of promotion.We have always held that what is best for the Army as a

whole-for the State, the soldier, and the service-is best forthe Medical Service itself, for it is by this standard and onthis ground that every scheme must, after all, be tried. Wehave no hesitation in saying that if the Army MedicalService has become very unpopular-and about this therecan be no doubt,-the authorities have themselves to thankfor it. From 1858 to the present time there has been aconstant struggle going on between the medical officers andthe authorities. The advantages and privileges attachingto relative rank, guaranteed by Royal Warrant, have been

dissipated away, and in some cases plainly abrogated, byWar Office circulars and official memoranda, until a spirit ofdistrust and discontent has become the prevailing feelingof the department. What yesterday happened in the caseof forage might to-morrow, it was felt, be applied to the case

of pensions. Then, again, let the change of system havebeen good, bad, or indifferent, the fad remains that LordCARDWELL’S ruling was of a retrospective character; regi-mental medical officers were, at one stroke of the pen, dis-

possessed of their appointments, and it was impossible forthem to shut their eyes to the very different measure dealt

out to the combatant branches of the service on the abolition

of purchase; the contrast between the extremely generoustreatment accorded to the one, in the shape of compensation,which was denied to the other, was too glaring to escapeobservation. Schemes for expediting promotion, too, weredevised and applied to the other scientific branches of theservice. And so things went on accumulating until the pre-sent War Minister found himself in a maze of difficulties from

which he probably saw no escape. This is a view of the matterwhich has never been honestly and fairly laid before theHouse of Commons; but Mr. HARDY has now, with the ap-proval, apparently, of the Opposition, cut himself free fromdifficulties brought about by the Government of this country,past and present. The development of unpopularity maybe slow and gradual, but its effects remain long after thecauses have been removed, as Mr. WARD HUNT finds to his

cost in the case of the Naval Medical Service. Mr. HARDY

has most emphatically pronounced his opinion that to returnto the regimental system is simply impossible, and he gavehis reasons for stating why such a return is undesirable, evenwere it possible. It is to be resrretted that he did not long

ago display the firmness he exhibited last week. Had he

done so, and redressed the more pressing grievances of thedepartment, there would have been no necessity to have re-course to his present expedient of short service. And this

brings us to the great novelty, the keystone, of the scheme.The service is to be constituted of two sections-a subordinate

portion, forming the great bulk of the department, com-posed of young medical men serving for a limited period ata relatively higher rate of pay, and with a bonus at the endof the term; and an upper and less numerous portion, con-

stituting those on permanent or continuous service, which isto go on for pension, and be fed by and drawn from theformer class by selection. This section will be chargedmore especially with the administrative and higher pro-fessional functions of the service. The other class, after

passing a severe competitive examination on entrance, willbe entitled to C250 per annum, plus allowances, and .61000on completion of their ten years’ service. If selected, how-

ever, to remain, they will pass into the upper or continuousservice, from which they will be compelled to retire

at sixty years of age if in the administrative ranks, or, if

not, as we understand it, at fifty-five years of age as atpresent. Mr. HARDY instituted a parallel between theMedical Service and a bottle. He said the bottle is a gooddeal larger than the neck, and as you cannot force all thecontents into the neck at once, you must draw some off

below, in order to get a fair proportion above. In that waythe most expensive retirements would be diminished, while,the number of those entitled to these and other good thingsbeing reduced, the medical officers’ chances of securingthem would be vastly increased and the character of the

service itself improved.,

That the scheme exhibits boldness and originality in de-

396 THE DEVELOPMENT OF OVA AND THE OVARIES.

sign, as well as plausibility, cannot be gainsaid; but thEquestion arises whether the experiment of short service willsucceed in attracting men from the medical schools so as tcrelieve the Government of its difficulties. Several thingsstrike us in regard to it. In the first place, are young medi-cal men likely to place implicit confidence in the promises ofGovernment ? They may feel that it would be as well forMr. HARDY to be just to the men he has got before beinggenerous to those he hopes to get. Will =8250 per annum

for ten of the best, although the least lucrative, years of aman’s life suffice to maintain the requisite flow of candidates ?It is not in human nature to be contented with the same

rate of pay for ten years; and it seems to us that if the

Government had given .,6300 with an increase, or, at anyrate, .6300, per annum, at the end of five years’ service, thechance of attracting a larger quantity, and certainly a betterquality, of candidates would have been greatly increased.Is not ten years too long a service for a professional man whointends entering on civil practice ? Will he not find him-

self outstripped by those who have (( remained at home atease," and resisted the Government bait ? 2 And is ten yearsof army life likely to prove a good training, on profes-sional and other grounds, for subsequent civil practice ? PAs to Mr. HARDY getting the flower of the medical schools,

we are utterly incredulous. The public services will neverattract such men in any numbers. The unsettled life and

uninteresting routine work will always prove irksome anddistasteful to them, and Mr. HARDY may be well satisfied if,instead of getting the flower, he succeeds in excluding theweeds. We imagine that at first candidates will be forth-

coming ; but in the matter of (( allowances" we see rocksahead. If Mr. HARDY be sincere in wishing to avoid thesehindrances, he will instruct the War Office to publish in themost precise, clear, and unambiguous language possible, andin some authoritative form, the exact terms he has to offer, soas to ensure that young medical men may know what theyare to get, and, what is more, that they may be certain of

getting it. There are three classes of students in most medicalschools. The best men look forward to holding hospitalappointments, and are ambitious of professional or scientificdistinction; these will not enter the public services. Others

are being educated to succeed to the practices of relativesor connexions; some, but not many, of these may tem-

porarily enter the service ; and there is a third class, withwhom the bait will take (with their parents especially),whose prospects at the completion of their professional edu-cation are uncertain and obscure. We must wait for the

new Warrant to discover what is to be the relative rank

assigned to the short-service men, and the way in which thequestion of Indian pay and allowances is to be met in theircase. It is idle to talk of what may occur by 1912. Bythat time " bloated armaments" may have burst up, or we

may have conscription, and the present Tory Governmentwill probably have passed into oblivion, and possibly evena descendant of ODGER or KENEALY may then be in the

ascendant, though we confidently hope not.As regards what may be termed the old medical service,

this must be regarded in two aspects-its present and

future condition. The military medical is no longer to

be counted a separate life-long service, requiring special

a training. Whilst the medical profession is being split ip,1 in this our day, into as many specialists as there are organs) in the body, Government is returning to the usages of a tunes when there was not that gem between the civil and military or- naval medical element that now exists. The present medealf service is, apparently, to be supplanted in process of timj byr another. We know nothing as yet of what Mr. HARDY has

done to redress the grievances of medical officers. HE has

i said nothing on this head, and we must wait for the newL Warrant. We cordially agree with Mr. HARDY, however, in) what he said about compulsory retirement at sixty. A

service without hope is without emulation, and consequentlystagnant; and it is but just to recognise that in this rspect

the War Minister’s ruling will be of signal benefit to thedepartment.As regards promotion, the principle of selection is to be

, the principle adopted in future. Theoretically, it is unques-tionably a sound one for a special service like that of the. medical department ; practically, its application must beattended with great difficulties. The question is one in

which the disadvantages of senile dulness or incompetence. are balanced against the abuses of favouritism and servility;

but let the head of the department apply the principle with. the utmost integrity of purpose for the good of the service,and for that object only, and he will still be lucky indeed if

he escape censure, as he certainly will not escape criticism.

A VALUABLE contribution to our knowledge upon theformation of ova in the foetal ovary has been made recentlyby Dr. FouLis, in a paper published in the Transactions ofthe Royal Society of Edinburgh. The importance of the

paper is considerably increased by the fact that it containson one or two points rectifications of the statements of

WALDEYER and others, which have hitherto been held to becorrect. One of those statements concerns the nature of the

ovary itself. Dr. FOULIS conclusively proves that it has no

right to be considered in any sense a tubular gland, and heshows clearly how the formation of the Graafian folliclestakes place without any such process as WALDBTEB

imagined. In this place it will suffice to follow closely uponthe descriptions of Dr. FOULIS, whose observations were madeupon the ovaries of the embryos of the cat, dog, rabbit, andman. About the earlier formation of these organs there is

now no dispute. Embryologists are agreed that on themedian side of the Wolffian body, the investing epithe-lium, continuous with the general epithelial lining of the

pleuro-peritoneal cavity, becomes thickened; its cells here

assume a columnar shape, they proliferate freely, and thusform a raised mass of " germ-epithelium." From this layerthe ova are subsequently developed, whilst the vascularstroma of the organ is formed by an outgrowth from theside of the Wolffian body. The activity of the processes ofgrowth may be conceived by the fact that at birth the ovary

contains no fewer than 35,000 ova. The production of these

takes place as follows : - The germ-epithelial corpuscles,composed of nucleated masses of protoplasm more or less

columnar in shape, rapidly proliferate. Then some of them

become spherical, their nucleus swells up, assumes a definitelining membrane, and contains a well-marked nucleolus. Eachsuch cell is a 11 primordial ovum," and in the human fcetal

397MEDICAL WOMEN.

oviry of seven months and a half there may be seen germ-

epithelial corpuscles in all stages of development into these

primordial ova. The nucleus of the cell becomes the germinalvesicle, and the nucleolus the germinal spot. Meanwhile the

delicate spindle-celled stroma grows into the germ-epitheliallaye?, here and there separating several of these corpuscles,of which others are produced on the surface to make up fortheir loss. The groups of corpuscles thus isolated are

destined to become groups and clusters of ova, for each of

the germ-epithelial cells within the investment swells up anddevelops into a primordial ovum. But these egg-clustersdo not long remain in this compacted condition; the stromalelements enter and isolate each primordial ovum just as thesolitary primordial ova found in the germinal layer areisolated. The adhesion between the spindle-cells and the

primordial ovum they invest is very intimate. The rapidproliferation of the germ-epithelial cells gives an irregu-larity to the surface of the young ovary so as to produce the

appearance of depressions, or even of tubes; but Dr.

FouLis is unable to trace the formation of any tubes of in-

volved epithelium with which the egg-clusters are attached.Each primordial ovum, with its thin investment of em-

bryonic connective tissue, constitutes a Graafian follicle.

Here, again, Dr. FOULTS has thrown much light upon anobscure subject. The mode of formation of the Graafian

follicle has been frequently described, and the most generallyreceived explanation is, that the follicle, with its " membrana

granulosa" and fluid contents, is derived, like the con-tained ovum, from the germ-epithelial layer-a view con-sistent with the tubular doctrine of the structure of the

ovary. According to Dr. Fouus, however (who has neverbeen able to see this tubular structure), the membrana

granulosa of the follicle is formed by modifications of thespindle-cell connective tissue composing the vascular stroma ;and he has been enabled to trace all stages in the process by

I

which the cells arranged nearest to the ovum become so con-verted. As the ovum itself increases in size, the layers ofcorpuscles forming the membrana granulosa increase. Some

of them remain surrounding the ovum; but a large numberdisintegrate, and contribute by their dissolution to form thefluid contents of the follicle ; while, lastly, one layer remainslining the whole follicle. This layer has received the nameof "follicular epithelium"-an appellation which cannot

strictly be applied to it, since it is developed, not from pre-existing epithelial elements, but from connective-tissue cells.We have already seen how the ovum is originally formed.It is completed finally by the thick translucent striated zonesurrounding the yelk. This zona pellucida is, according toDr. FoULis, a production, not of the follicular epithelium,but of the yelk itself. It consists merely in the hardeningof the outer layers of the yelk. To appreciate the distinctionthus raised, it is necessary to consider the origin of the yelkitself. This, according to PFLUGER, WBZDEyE, and others,is, even in the mammal, in the mature ovum, composed oftwo parts-the central portion, or principal yelk, being thatwhich immediately surrounds the germinal vesicle. This is,of course, the product of the protoplasmic contents of theprimordial or germ-epithelial cell. But to this, according tothese authors, there is added at a subsequent stage a layerof yelk, called secondary, investing the primary yelk, and in

close contact with the zona pellucida. This, they maintain,is the product of the follicular epithelium, and hence, fromtheir point of view, it would be equally consistent to saythat the zona pellucida was formed from the transformation

of the outer yelk-layer or directly from the follicular epi-thelium. But on Dr. FouLIs’s view this double source forthe yelk in the mature ovum is unneeded, as is shown byexcluding the follicular epithelium from any share in theproduction of the zona pellucida. It may, however, beassumed to take place in part from the conversion of thestromal cells; but this does not seem to be Dr. FouLis’s

opinion.It is, then, upon the points as to the non-existence of

tubular structures in which the Graafian follicles are formed,the important part played by the stromal tissue in the

formation of these follicles, and the mode of origin of thezona pellucida, that the conclusions at which Dr. FOULIS hasarrived differ so materially from those of the German

histologists. His paper is so carefully written, and everystep in the developmental process is so fully illustrated, thatthere seems good ground for believing in the accuracy of theconclusions at which he has arrived.

THE agitation for the higher medical education of womenpresents many unmistakable signs of an approachingmaturity. Already the question is passing beyond thecontrol of the examining boards and medical corporations,and is rapidly assuming more and more a political cha-racter. The fact becomes every day more manifest that the

importunity and the earnestness of the medical women

advocates will ultimately prevail. The deputation whichthe Duke of RICHMOND and GORDON received last week had

evidently realised this. One member of the deputation evenwent so far as to allege that the Government could nowdeal with the question of the registration of properlyedu-cated medical women with less difficulty than formerly,because the prejudices of medical men were graduallydiminishing, and because a majority of the medical journalswere now either in favour of medical women or were at leastneutral. On what facts this statement is based we know

not, nor can we conjecture what medical journals are com-prised in the majority. A feeling has, it is true, been

gradually engendered that anything would be preferable tothe worrying and harassing interference of the few womenwho are so impatient to distinguish themselves as medicalpractitioners. For ourselves, we have always maintainedthat female medical practitioners are neither necessary nordesirable, and to this opinion we still adhere. But, on theother hand, we should not be sorry to see the obstacles tothe registration of properly qualified women removed, if bythat means the discussion on the medical rights of womencould be for ever got rid of. Unfortunately the mattercannot be so easily dismissed. To remodel laws or to alter

regulations that have for years received the sanction of allintelligent and well-infoimed persons, without a sounder

justification than the gratification of the whim or the

caprice of a few female enthusiasts, is neither prudent norreasonable. Many of the wcmen who are now aspiring to

Medical practice have not hesitated to declare that it is

neither their intention nor desire, if admitted into the pro-

398 THE ELEMENT OF TIME IN CHRONIC DISEASES.

fession, to restrict themselves to the study and treatment ofthe diseases peculiar to their own sex, but that, in the wordsof one of their warmest admirers, " they desire an education

complete in all its branches and a diploma qualifying themfor general practice." In this they are doubtless to a greatextent right, but it will, we venture to say, be many yearsbefore the Government of the country, the members ofthe medical profession, and the public generally, will beeducated up to the opinion that women should be made

competent to attend any man who might be induced to

seek the services of a female medical practitioner. If those

women who are seeking, at an extravagant cost of time and

money, to enter the medical profession, were content towork in the only department of medical practice which is

properly open to them-namely, as midwives and nurses,-no objections could fairly be raised, provided that theyalways practised under the supervision of qualified medicalpractitioners. The King and Queen’s College of Physiciansin Ireland two years ago adopted a bye-law which exactlymeets such a contingency. A licence is granted to thosefemales who have complied with the necessary regulationsto practise as midwives and nurse-tenders. The regulationsare that the candidate shall be not less than twenty-oneyears of age and of good moral character; the passing of apreliminary examination in reading, writing, and arithmetic;and six months’ attendance on systematic lectures on mid-

wifery, and not less than six months’ attendance on bedsideinstruction in a lying-in hospital or maternity recognised bythe College; the subject of examination being Midwifery(not including operations) and Nurse-tending. But this is

a very different affair from what the female medical students

in London are striving after. Their ambition is to be placedupon the Medical Register, and then to please themselveswhat branches of medical practice they shall engage in. Butthis is exactly the matter in dispute between them and thosewho differ from them.

Annotations."Ne quid nimis."

THE ELEMENT OF TIME IN CHRONICDISEASES.

THE element of time in diseased processes is one thatdeserves yet more attention than has been given to it byphysicians. It has not been unconsidered in certain classesof disease. From the days of Hippocrates downwards,certain diseases have been considered subject to laws of time,and not the least interesting part of recent additions to ourknowledge is that which shows that diseases neither specificnor infectious are subject to such laws. In pneumonia, forexample, a marked tendency to crisis was pointed out byLaennec, and has been noticed by other careful observers.So with some other acute diseases. But there remains the

large class of chronic diseases in regard to which we knowcomparatively little with any certainty as to their relationto time, save that they do not seem bound by any definiterules, and that they extend over vague and various periods.The chief aim of medicine in regard to such diseased

processes, where they cannot be entirely removed, is so to

attenuate their rate of progress that it shall not seriouslyaffect the duration of life or even its comfort. A very I

, suggestive and interesting case was detailed by Dr. I.

; Burney Yeo, in THE LANCET of January 29th. The case

was one of cancer of the stomach, in which a period of noless than seventeen years elapsed between the first iadica-tions of the disease and the fatal ending of it; theIe were

, considerable intervals of comparative health, which led veryeminent physicians to doubt the cancerous character of thecase. Suitable food, as animal jellies and fluids, such ascould be absorbed by the stomach itself, with appropriatemedicines, almost to the last greatly alleviated the painfulsymptoms of the disease. At the last, at the age of sixty-two, death was occasioned by the patient indiscreetly grati-fying an unusual appetite, and taking first" a rathercopious breakfast and afterwards a good dinner." Perforationtook place, and subsequent peritonitis, but for which itseems probable that life would have been still further pro-longed. It is not our design here to discuss the means bywhich the rate of progress of cancer may be most effectuallyextenuated. At a comparatively early period in thiscase a sound but a very depressing diagnosis had beenmade and expressed by a most competent physician. Per-

haps few things tend more to intensify the rate of

progress of cancer than a medical diagnosis of its actualexistence: a fact which raises a most important questionin medical ethics-how far it is right to express such anopinion to a patient where the question is not speci-fically raised and urged by himself. This point apart,we have here a striking instance of a cancer takingseventeen years to kill; and the question arises, If a can-cerous process can be so retarded, why should it not be stillmore retarded? We see no reason why such retardationshould not take place. One of the recent changes in medicalfaith is belief in the possibility of indefinitely retarding dis-eased processes of the tubercular order. Dr. Dickinson tellsus that the diabetic process may be extended over fifteen

years. But why fifteen? except for the fact that cases havenot been watched over a longer period. Such facts are veryimportant. Morbid processes which occupy so large a partof the natural period of human existence remind us of

Pope’s words-"’1;hat long disease, my life ;"

and make us hope that, by some " gentle arts," they may beso attenuated as to take the form of age rather than disease.We should be greatly indebted to readers for information ofwell-authenticated instances of the abeyance of ascertainedorganic disease, or of the remedies, diet, or general circum-stances which tended to their abeyance. It is evident thatchronic states of disease are greatly capable of being soinfluenced. We all know of lives that in a medical respectare damaged, but which are amongst the best lives we know,and even the longest. We have to be to them whatArbuthnot was to Pope, and which Pope so happily acknow-ledged-

"Friend to my life ! which did not you prolong,The world had wanted many an idle song."

HUMAN ANATOMY AT CAMBRIDCE.

WE are glad to find that the Senate of the University ofCambridge have confirmed the Report of the Board ofNatural Sciences Studies, and have given a more prominentand definite place to human anatomy in the examinationof the Natural Sciences Tripos. Not merely is this a re-cognition of the fact that human anatomy deserves to beregarded as a science, but it is, we bopp, also an assurancethat it will be so taught in Cambridge. As the specialstudy of one member of the animal kingdom, and that theone which we are in the habit of regarding as the highest,we can see no good reason for excluding it from the higherstudies of the University, and we apprehend that it is