412

THE LANCET.

LONDON: SATURDAY, FEBRUARY 22, 1890.

I’ROPOSED IIECONSTITUTION OF THE UNIVERSITY OF LONDON.

THE movement for adding a teaching side to the Univer-sity of London is undergoing another development. For the

scheme which was presented by the Senate of the Universityof London for consideration by the representatives of

University College and King’s College, as a basis of con-ference, another has been substituted, in accordance withthe views of Professor CAREY FOSTER, who is both a

member of the Senate and a professor on the teaching staffof University College. It follows the provisional scheme ofthe Senate of the University in its main clauses so far as theconstitution of the University, the personnel of the Senate,and the formation and powers of Faculties and Boards

of Studies are concerned, but makes more liberal concessionsto the teaching colleges in respect of the granting of degrees totheir own students. Instead of exempting such students frompassing the Matriculation Examination on certain con-

ditions, this scheme proposes that all candidates shall passthe same Matriculation Examination, but that at all exami-nations subsequent to this, "the scope of each, so far asdeciding the general subjects to which it shall relate, is to bedetermined by the University; but the details shall be de-cided, in the case of students of a constituent College, notby syllabuses issued by the University, but by the courseof instruction given in the College." Further conditions

are laid down to ensure that such courses amount to an

adequate treatment of their respective subjects, and, by asso-ciating an external examiner appointed by the Senate withthe College professor, to secure an effective control by theUniversity over the Collegiate examinations. A conferenceon this new basis is to take place next week. But these

proposals concern only the Faculties of Arts and Science,those of Medicine and Laws being expressly excluded fromProfessor CAREY FOSTER’S scheme; so that the originalsuggestions as to a lowered preliminary scientific examina-tion, and the establishment of an inferior grade of

Doctors of Medicine, still stand as part of the scheme.

Whether University and King’s Colleges will agree to theproposals now put forward we cannot tell. If they do,however, the possibility of forming a real local and teach-ing university in London, with the function of grantingdegrees to London medical students on fair and equitableterms, will unfortunately be rendered more difficult, forwe should have to look elsewhere than to those teachingcolleges for the Faculties of Arts and Science. A specialpoint which has to be safeguarded is that London medicalstudents should no longer continue under their present dis-

abilities, and there is no slight danger that if the require-ments of the professors in arts and science are granted by theSenate, and can be passed through Convocation, the clausesrelating to the Faculty of Medicine may be dropped. In

such a case the medical examinations would remain

" Honours Examinations," as they are called by the RoyalCommissioners; and as the Royal Colleges are expresslyrefused powers to grant degrees by these Commis-

sioners, the medical student in London would be left

in his present condition, with his grievances, now

publicly admitted in the report of the Commission, un-

redressed. It is absolutely necessary that the teachers inour medical schools should take steps to prevent such adisastrous termination to the agitation, for it is suflicientlyclear that the Senate of the University, even if they had thedesire, are powerless to push the medical part of their schemethrough Convocation. We question if, in the event of

their offering privileges which would satisfy the teachingcolleges, those proposals would be accepted by Convocation,whilst the clauses affecting medical subjects will scarcely finda single supporter in that body. The authorities of the

University of London are placed in a very diflicult positionin respect of medical degrees. The graduates most

strenuously object to these being lowered. The RoyalCommissioners state that this must be done ; but the

institution of a lower-grade degree would bring the Uni-versity into conflict with the Royal Colleges of Physiciansand Surgeons, whose licence-giving power would then beseriously endangered. A new teaching university would befree, and could recognise the strictly technical examina-tions of these corporations. As was clearly pointed out lastweek to the deputation from the provincial colleges by theLord President of the Council, the Commissioners were

unanimous on one point-that there ought to be some

teaching university for this vast metropolis. If the existingUniversity takes up this work, it must do so in earnest, andnot merely in a niggardly fashion under compulsion.Professor LAWSON TAIT may urge that this is not

needed, and that Birmingham students only desire to beaffiliated to the University of Durham. With regard to thismatter, however, it will be seen, by reference to the letterof our Birmingham correspondent, that the Senate of thelatter University " regret that the time does not appear tothem to have arrived when it would be desirable to affiliate

the medical department of Queen’s College with the

University." If this University had given exceptionalprivileges to any other medical school than its own, suchprivileges would have been demanded by, and must have beenaccorded to, every other school in the kingdom not affiliatedto a university, and we would point out that no Londonmedical school is affiliated to the University of London, or hasany special relation to, or connexion with, that institution.

WE have from time to time directed attention to the in-

significance of certain conditions of the uterus which havebeen supposed to hold an important place in the pathologyof that organ, and have combated pathological theories

which are not only wrong, but which also involve methodsof treatment that are often dangerous to life and generallyinjurious to the health both of body and mind of the

patients concerned. It has been a misfortune to women

that from the time---now fifty years ago—when attentionbecame directed to the diseases peculiar to the sex, theirstudy has proceeded along very narrow lines, and patho-logical theories have been formulated upon insufficient andoften erroneous data, and made the basis of universal treat-ment. At one time inflammation of the cervix was the

theory generally accepted, and its treatment consisted in

413THE ABUSE OF UTERINE TREATMENT.

the application of caustics to the os uteri once or twice aweek for months. After a time stricture of the cervical

canal shared the field with inflammation, and this

was supposed to be cured by the introduction of

bougies at weekly intervals for an indefinite period.Subsequently flexions were discovered, and displacementswere soon magnified into an efficient cause of all the ills ofwomen, and upon them was built the superstructure called" the mechanical system of uterine pathology." Their

treatment by pessaries of all kinds, shapes, and substancesfollowed as a matter of necessity, and the pessary requiredsuch careful looking after that in many cases it demandeda daily visit. After this the great discovery of conical

cervix and pinhole os was made, and chronic inflammationand stricture of the canal rapidly retired from the field.This discovery demanded a cutting operation, and the wear-ing of a stem for weeks or months. The method proveddangerous, occasionally even fatal ; it has, however, been

practised to a large extent, and is still occasionally adopted.Yet later, laceration of the cervix was discovered to be the

great cause of suffering in women, and " the greatest surgicaltriumph of this century " was invented for its cure. This

surgical triumph consists in paring the lacerated surfacesand stitching them together. Then massage came to the

front. It is true that this mode of treatment is not speciallydirected to the cure of uterine diseases, but rather to the cureof cases which a few years ago would have been regardedas uterine, and would have been treated on one of the plansenumerated above. These are some of the theories which

have been held with regard to the diseases of women and themethods employed for their cure. Against these views andmethods of treatment the voice of the more thoughtfulpractitioners in this country has often been raised, but inAmerica "minor gynæcology" of the worst type has alwaysbeen encouraged, and its practitioners have been regardedas the advanced guard of the department, so that we findourselves pleasantly startled and surprised on reading apaper by a leading American physician, Dr. GOODELL of

Philadelphia, on the Abuse of Uterine Treatment throughMistaken Diagnosis, published in the Medical News. Weheartily congratulate Dr. GOODELL on his emancipationfrom views, some of which have been proved by laboriousresearches to be wrong, while others are, on the surface,of such an improbable character that they should bereceived only on the production of irrefutable proof of theircorrectness.

It has hitherto been the custom among certain gynoe-

cologists to accept any theory of uterine disease putforward unless it is disproved. No custom has been more

disastrous to the scientific progress of this departmentof medicine, and it should be reversed ; no theory, bywhomsoever advanced, should be tolerated unless proof ofit be forthcoming. Had this rule been observed, uterine

pathology would not have been in its present chaotic state,and Dr. GOODELL would not have to complain of the abuseof treatment through mistaken diagnosis. Dr. GOODELL

concludes his paper with the following watchwords as broadhelps to diagnosis.

In the first place, " always bear in mind, what anotherhas pithily said, ’that woman has some organs outsideof the pelvis.’ Each neurotic case will have usually

a tale of fret or grief, of cark and care, of wear andtear. Scant or delayed or suppressed menstruation isfar more frequently the result of nerve exhaustion than ofuterine disease. Antellexion per se is not a pathologicalcondition. It is so when associated with painful menstrua-tion, and only then does it require treatment. An irritablebladder is more often a nerve symptom than a uterine one.In a large number of cases of supposed or actual uterinedisease which display marked gastric disturbance, if the

tongue be clean, the essential disease will be found to beneurotic; and it must be treated so. Almost every sup-posed uterine case characterised by excess of sensibility andby scantiness of will-power is essentially a neurosis. Inthe vast majority of cases in which the woman takes toher bed and stays there definitely from some supposeduterine lesion, she is bedridden from her brain, andnot from her womb. I will go further, and assert thisto be the rule, even though the womb itself be displaced,or it is disordered by a disease or by a lesion that is not initself exacting or dangerous to life. Groin aches and soreovaries are far more commonly symptoms of nerve exhaus-tion than of disease of the appendages. Uterine symptomsare not always present in cases of uterine disease. Norwhen present and even urgent do they necessarily comefrom uterine disease, for they may be merely nerve counter-feits of uterine disease."

In the main these conclusions are sound and healthy,but the author shows some hankering after his old

views, especially with regard to anteflexion, and a littletoo much affection for his new love - nerve exhaus-

tion,-a syren which has proved as dangerous as any

uterine fad. In spite of these blemishes, we cannot

help feeling that the outspokenness of Dr. GOODELL willprove an enormous benefit to the study of the diseases ofwomen in America. Already even the effects of this out-spokenness are observable. In a discussion on painfulmenstruation which took place recently in the ObstetricalSociety of Philadelphia, only a small number of the speakersproved themselves to hold orthodox views upon " minorgynæcology." The majority expressed views which werestrongly antagonistic to the meddlesome local treatmentwhich has been in favour for so long a time. This is highlysatisfactory. We shall accordingly look forward with

pleasure to sound scientific and pathological work fromthe obstetricians of America, instead of the ‘ inventions"in pessaries, instruments, and minor operations for con-

ditions of which so little is known.

WE have received a copy of a report submitted to

the Worcester County Council by their SanitaryCommittee, in which the grounds are set forth which, .in the opinion of the committee, necessitate the appoint-ment of a medical officer of health for the county. The

Council were doubtless largely influenced by this report intheir recent decision no longer to postpone making such anappointment; and since it has been alleged by some CountyCouncils that until the transference to them of the powers,

duties, and liabilities which were embodied in the Pro-

visional Order of the Local Government Board of June 4th,1889, made under Section 10 of the Local Government

Act, 1888, and which Order has not yet been confirmed,it is useless to appoint county health officers, it will be wellto note the experience in this matter of a County SanitaryCommittee who have been anxious properly to fulfil their

414 THE NEED FOR COUNTY HEALTH OFFICERS.

duties. They state, generally, that they have found them-selves to be fettered in the exercise of the powers conferred

upon them in consequence of the postponement of the

appointment of a health officer to advise them ; and

they then proceed to enumerate some of the dif6-

culties which they have had to contend with. Thus,the Improvement Commissioners of Stourbridge have for-warded to them an application, in which complaint is madeof the foul state of the river Stour-a complaint whichthe committee believe to be well founded. But before

the question can be entertained by them they declare it ’’

to be necessary that they should have a report from anexpert, specifying the nature and the extent of the

pollution in question. It is known that the grievanceis a serious one and of wide extent, and it is stated that

even a preliminary report would necessitate an expenditureof at least fifty guineas, further expenses being involved atsubsequent stages of the proceedings. And this is only oneout of a number of similar remonstrances certain to be

made as to the state of the streams within the jurisdictionof the county. Therefore the expense of the proceedingsmust necessarily be very heavy as well as uncertain,unless the matter could be dealt with, and the neces-

sary scientific evidence be largely obtained, through theservices of a permanent health officer. Then, again,the Council have instructed their committee to preparethe requisite bye-laws for the prevention and suppres-sion of those nuisances not already punishable in a

summary manner by virtue of any Act, a power which isconferred upon County Councils under the Local Govern-ment Act. Here, also, the Sanitary Committee have failed;for they report that, in the absence of the advice of amedical officer of health, they have not found themselvesable in a satisfactory manner to frame any such code as is

required.As is well known, it is the duty of medical officers of

health for local districts to send to the Councils of their

respective counties copies of their annual reports. This

requirement, as pointed out by the Sanitary Committeeof the Worcester County Council can only be properlyfollowed out provided the reports are carefully consideredand their matter collated for the purposes of the whole

county; and this duty is, obviously, one that must be per-formed by a superintending health officer. And, in the

county of Worcester, twenty-six out of a total of thirty-sixsanitary authorities have already adopted the InfectiousDisease (Notification) Act of 1889. If this Act is to be of

any substantial use, all reports made under it ought, aspointed out by the committee, to be available for certaincounty purposes. To this end a summary at least of the

material they severally contain ought to be sent periodicallyto a county focus, where the material could be so collatedas to be at once made serviceable for all the sanitaryauthorities within the area of the county; and here again amedical head is absolutely needed.For these and other reasons the committee strongly urge

the appointment of a thoroughly skilled health officer; andso convinced are they of the necessity for taking this actionwithout further delay that they submit to the CountyCouncil that they can no longer satisfactorily continue tofulfil the duties laid upon them in the absence of such an

officer. This report, we find, was adopted by the Councilon the 3rd inst., and we trust that the explanation offeredas to the principal grounds which influenced them in

taking the action they have done may be helpful to otherCounty Councils who are still hesitating in the matter.

Annotations.

ROYAL COLLEGE OF SURGEONS.

14 Ne quid nimiq."

AT the end of last month a deputation from the Associa.tion of Members of the Royal College of Surgeons attendedupon Lord Randolph Churchill by appointment to discusswith him the steps to be taken for promoting in Parliamenta Bill to give effect to the College franchise reforms so longadvocated by the members. Lord R. Churchill, after care-fully considering the matter, expressed himself entirely infavourofthe movement, but recommended that, in view of thelarge number of Bills about to be introduced into the LowerHouse this session, it would be advisable to endeavour to

bring this Bill before the House of Lords in the first instance.He therefore recommended the deputation to ask LordDunraven to move for its introduction in that House, andpromised to write to the latter peer inviting his attention tothe matter. In the result, Lord Dunraven received onJan. 30th a deputation of Members of the Royal College ofSurgeons, introduced by Dr. Danford Thomas and attendedby Mr. B. F. C. Costelloe, the counsel for the plaintiffs inthe Chancery action, " Steele v. Savory." After a long andsympathetic hearing of the Members’ grievances Lord

Dunraven promised to give the subject his best attention.We are now informed that a few days ago Lord Dunravenwrote to the introducer of the deputation saying that "hewill be pleased to introduce a Bill into the House of Lordson the lines suggested."

--

THE STATISTICS OF LUNACY.

A LONG and careful examination of the materials at

present available for illustrating the statistics of lunacy,which was submitted by Mr. Noel A. Humphreys to theStatistical Society on Tuesday evening last, resulted in

confirming in a striking way the main conclusions on thisimportant subject for which we have repeatedly contendedin these columns. The apprehensions which have in recentyears been generated by a superficial reading of the figuresfrom time to time published by the Lunacy Commis.sioners were shown to be, if not absolutely unfounded,at least very exaggerated, and quite unwarranted bythe facts. It has frequently been stated by the com.

missioners themselves that grounds exist for the conclusionthat year by year a constantly increasing proportion of theinsane population is brought within their jurisdiction, andMr. Humphreys has illustrated this proposition by a numberof ingenious investigations. He has shown most satisfac-

torily, by a comparison of the census returns with thosemade by the commissioners, that there exists outside theinstitutions over which they exercise oversight a large bodyof insane persons, forming a reserve from which it is quitepossible that, as the custom of consigning the mentallyunsound to asylums grows in popularity, a large acces-sion to the ranks of the registered insane should be forth-coming. He shows also that the increment which has

actually been recorded agrees strikingly in some of itsfeatures with what might he anticipated to be thecharacter of such a growth of numbers as might arisefrom this cause; for the rate of increase from year to

year exhibits a steady and even a rapid diminution. If the