WITHIN the last few weeks the New Royal Infirmary has been publicly opened, and the good work so long carried on in the time-honoured and far-famed Edinburgh Infirmary has been transferred to the new and magnificent premises. The public interest in the institution has been shown not merely by good wishes for its future prosperity, but by practical beneficence-the free-will offerings for the purpose of having it thoroughly furnished and equipped for the work to be done.

Fully sympathising with this well-placed enthusiasm and in the glowing anticipations of increased usefulness, it may yet be permitted to one who has long and kindly remembrances of the "Old House" to look back and linger a little as he says good-bye to it. The "Old Royal Infirmary of Edinburgh," so well known to the medical profession everywhere by reputation, so lovingly esteemed by all who had studied there, and not less by those who had themselves been recipients of its benefits. What memories are associated with its early days-memories of Monro, Cullen, Gregory, John Bell, and a host of others! How soon it became known as a great clinical school, and attracted men from all parts of the world to study in Edinburgh! We have no intention, however, of giving anything like a history of the Infirmary; we leave that for abler hands. All we profess to do is to give our personal recollections of the Old Infirmary as we first knew it, and of the extensions and changes which have taken place from that time until now, when it is left uninhabited except by the memories of the past.

Our earliest recollections of the Infirmary date from a period when we passed it daily in going to the Old High School. Then we viewed it with a certain awe due to the mythic legends current in the School as to deeds done within its walls; and we, moreover, somehow connected it with Dr. Barclay's Museum-"a chamber of horrors," in which, from the playground, we saw, or imagined we saw, skeletons hanging from the roof.

A few years passed, and we found ourselves a neophyte in the mysteries of medicine and a pupil of the Royal Infirmary of Edinburgh, then limited to the original Infirmary, or that part of the building which is now-or, at least, was till the last few weeks-known as "The Medical House." The Hospital of our student days (say, somewhere about 1829-30) consisted of a long central block and two shorter lateral blocks or wings. When viewed apart from its present surroundings and the irregular mass fof buildings with which it has gradually become connected, the original Infirmary must have been-indeed, is still-a very fine building, in the Scoto-French style of the eighteenth

century. The centre of the middle block presents a very handsome façade, surmounted by a dome and lantern dome; and in an alcove in the façade is a full-length statue of George II. The grounds are enclosed behind by the city wall, and in front by a lower wall, in the centre of which is a very fine ornamental gateway, approached by a flight of broad steps. We say an "ornamental gateway," because, being approached by steps, it is obvious that carriages could never have been intended to enter, and even the most majestic of "Provosts" might have felt small had the massive portals swung back to admit him. We believe it never has been opened in the memory of the "oldest inhabitant." The carriage entrance, ever since we remember (we are not the "oldest inhabitant"), was through a wooden gateway to the west of the ornamental one. The entrance for pedestrians, with which we are best acquainted, was by a small door still further west. By that narrow way we made our first entrance, and by it we will take our readers along with us into the Royal Infirmary.

As we open the door, we find ourselves confronted by a sort of den-by courtesy, the porter's lodge-in which is seated a burly official decked in the costume of beadledom, a large cocked hat, and blue greatcoat with red collar. His proper name was Phillips, but better known to students of that time as Cerberus, or St. Peter, according as their tendencies were mythological or theological. On our entrance he rises, not to do us honour, but to demand our ticket; and having been shown that, he allows us to pass. He had a keen eye for strangers, and was a terror to evildoers-that is to say, to any "Humanity "(a) who, in his character of student, wishing to see an operation, tried to pass as a "Medical": the eye of "St. Peter" marked him, and he was ignominiously rejected from the sacred gate. But we

have entered. We pass along the pavement in front of the west wing of the building till we come to the side entrance leading to the staircase of that wing, and on the ground floor is the general waiting-room. Disregarding the patients for the present, we pass on through the room to what was the public bath-room of the Hospital, not used by the patients but by the citizens, for it was the only public bath in the city until very shortly before the period we are speaking of. The memory of Royal patronage still clings to it, for here, in 1822, "the First Gentleman of Europe" (George IV.) performed his ablutions. The room is somewhat octagon in form, with a high groined and ornamented roof; the floor paved with squares of marble, and the bath also marble. Dusty and deserted now, it still preserves the characters of

(a) Student of University Latin Class, "Liters Humaniores."

former grandeur. The episode of the "regal bathing” in the Infirmary stimulated the citizens to get up public baths to supply a felt deficiency. These flourished for a time, but have now nearly ceased to exist, simply because scarcely any private house lacks that useful luxury.

Having now satisfied curiosity and performed the "Kotou" to Royalty, we proceed into the Hospital by the main entrance. We find ourselves in a large square hall, well proportioned and handsome as a whole, though not so lofty or so well lighted as to accord with modern taste. The roof is supported by pillars. At the back of the hall, opposite the entrance, is a recess or alcove, in which stands a bust of Provost Drummond, to whose exertions the original Infirmary owed its existence. A stove for heating and ventilation occupied the middle of the hall. To the west of the alcove is a small office for the head porter; to the east is the opening of the main staircase; and from either side of the hall there is a long and rather narrow passage leading to the administrative offices and store-rooms. The walls of the great hall are painted in panels, within which the benefactors of the institution are appropriately emblazoned in letters of gold. As we look on these records of goodwill and charity from the earliest days of the Hospital until the present time, there is much to make us linger, much suggestive of thought and sympathy. There are names well known to history, donations from kings and queens, many noble names amongst them: John Duke of Argyle and Greenwich, the patriotic statesman of George II.'s time; and in 1748 (three years after Culloden) the less loved name of William Duke of Cumberland; in a later panel David Hume and Commissary Smollett. Then there are receipts from assemblies and fancy balls for the benefit of the Infirmary at various dates, some of which must have been held in the old Assembly Close, and others more recent in George-street. And there are some subscriptions which speak to us of that large charity and loving spirit, unfettered by local interests, which is ever ready for good works anywhere. Such is the subscription from the Society of Friends, composed of subscriptions from almost every county in England and many parts of Ireland and Scotland-each place credited with the sum subscribed, and the whole summed up in business-like fashion into a grand total. Others, such as subscriptions and legacies from the West India Islands (then the "El Dorado" of Scottish youth), show the strong love of country and kindly memories of a home left long years ago, when they were poor Scotch lads forced to leave it to fight the hard battle of life.

But we must linger no longer. As we passed through the hall lately we observed the names and donations on the panels being copied, so we hope it is intended to perpetuate these records of past beneficence in the New Infirmary.

As we ascend the main staircase we observe large windows placed at different points, by which, together with the current of air from the entrance hall, ventilation is maintained, and by opening these windows fully the staircase can be thoroughly flushed with fresh air when necessary. On reaching the first-floor landing we find ourselves in front of the board-room door. The board-room occupies the whole length of the middle portion of the great central block. At each end of this landing are the entrance doors of the long wards. We see the large space which intervenes between the ward entrances, and we may notice that this space is being constantly ventilated by the current of air passing up from the entrance hall and staircase, so that practically there is no direct communication between the wards. Let us now enter one of these wards, say the west or male ward, known to Infirmary pupils as "No. 1 Medical." We find ourselves in a long ward having windows on both sides and an open fireplace at each end, its general character being that of a ward of the modern pavilion system. The roof is low in proportion to the length of the ward; the windows numerous, but small, and, being set deep in the thick walls, the light is somewhat defective; the double row of light pillars which support the roof also interfere with the spaciousness of the ward. Even yet, however, these are not bad wards, and when new and clean must, in the early days of the Hospital, have been looked upon as exceedingly fine. A door at the further end of the ward opens on the landing of the side staircase, and opposite, but at some distance, is the entrance of the ward of the corresponding wing of the Hospital. Here again we notice how the current of air passing up fills the interspace between the ward entrances, making a sanitary break between the two.

We have thought it well to give this general description of the Hospital, to show that in its construction the sanitary arrangements for natural ventilation by doors, windows, and fireplaces, and the position of the different staircases as airshafts in relation to the wards, must have been carefully considered by those who projected it according to their lights.

The surgical department appropriately occupied the highest position, for it was at the top of the house-the male wards on the west, the female wards on the east; whilst the great operating theatre occupied the central part of the building, under the dome which formed its roof, admitting light from all sides, whilst large windows on the north side gave steady light in that direction. The theatre had two entrances-one on a level with the wards, the other higher up, reached by a narrow stair. The general appearance of the theatre was steep, well-like, and sombre, owing to the dark colour of the wood and walls. The area was rather compressed. Compared with the magnificent theatre subsequently built, when the old High School received the surgical department, the original theatre looked small and dingy. It was not so dark, however, as it looked, for the light was well arranged as regarded the operating table. It was the scene of great operative exploits, and associated with great names in surgery. We recollect, as if it were only yesterday, the first operation we saw performed there. It was out of "canonical hours." We were seated in Mr. Liston's class-room, waiting for lecture, when he entered and told us he had been summoned to an urgent case at the Infirmary, adding that as there would likely be an operation the class had better be off to see it. His advice was promptly followed. There were very few present except Mr. Liston's class and some of the hospital residents and dressers. The operation was amputation of the thigh for spreading gangrene in a man whose leg had been crushed by being caught in a warp. The operator was the late Dr. John Campbell. Liston assisted him, compressing the femoral artery. There was little time lost in preliminaries-for there were no anæsthetics in those days,-and the limb was soon off, the vessels tied, and the stump very lightly dressed, and the patient, who made but little exhibition of suffering, was removed, and we retired after seeing our "first operation." After that we saw many brilliant operations performed in that old theatre by Liston himself, with a dexterity and skill we have never seen equalled.

(To be continued)

OBSTETRICAL SOCIETY.-The next meeting of the Obstetrical Society will be held, not on the first, but on the second Wednesday in January (14th).

THE FIRST INEBRIATE ASYLUM IN GERMANY.Dr. Pelman gives in the Deutsche Med. Woch. for December 6 an account of the first asylum for dipsomaniacs which has been recently established in Germany in imitation of the American asylums. In the year 1851 a Deacon-brotherhood establishment was opened at Duisburg, in the little town of Lintorf, near Düsseldorf, for the reception of discharged prisoners and ruined men. It was not originated especially for drunkards, but the numbers of these have gradually increased, and of 440 men who in the course of time have found refuge there, 301 have been received on account of a mania for drink. They remain there upon an average at least a year, leading a well-ordered, laborious life, the payments being only from 150 to 450 shillings a year. Although only intended for the lower classes, many who have been received there have seen better days and have moved in the higher circles. At the meeting of the German Lunatic Asylum physicians at Hamburg this year it was determined to attach to this establishment at Lintorf a spacious and handsome establishment for the reception of drunkards in a higher position in society, in which every appliance for their comfort and improvement should be supplied. This has accordingly been done, and the payment has been fixed at 150 shillings. per month for the first class, and 100 per month for the second class of patients. The only defect, Dr. Pelman observes, is that there is no compulsory power for retaining patients a sufficient time for their cure, instead of imitating the "practical English," who have provided that when a patient has once consented to enter an establishment he cannot leave it of his own accord. He does not seem to be aware that the "practical English" have not as yet had any experience of the working of this provision.

Chapter III. deals with the Injuries of the Head, Face, and Neck. The objections to sutures in scalp wounds are deemed groundless; local applications in erysipelas of doubtful value. Neuralgia and epilepsy are said to be not uncommon sequences of scalp-wounds, and the excision of the scar is recommended -a case permanently cured in this way being quoted,-whilst further on (page 305) trephining for some cases of such affections is advised. Suppuration between the inner table of the skull and the dura mater is not always indicated by Pott's puffy tumour, nor does the tumour always indicate internal abscess, but when the tumour is present, and trephining employed, the incision should be made through it to the bone. Fracture by contre-coup is described as a term to be abolished. In cases of scalp-wound with a question of fracture, scraping away the periosteum and pouring in a coloured fluid such as ink to stain the crevice, if such exists, "should never be employed unless there is an urgent necessity for so doing." We hardly know which most to wonder at, the idea of such a proceeding, or the half-hearted condemnation of it! Trephining is not recommended in fracture with depression, or with depression and comminution, in the absence of all symptoms of compression. In fracture with depression and signs of compression in adults, the sooner the operation is done the better, but in the case of children it is best not to proceed too precipitately. In compound fractures with depression, whether accompanied by symptoms of compression or not, the use of the trephine or elevator is proper. Punctured wounds of the vault also require the trephine as a preventive measure. Altogether eight conditions are enumerated which call for trephining. The treatment of salivary fistula is more fully described than usual in text-books. The division of the three branches of the fifth nerve is extolled in the treatment of neuralgia when constitutional remedies have failed.

Chapter IV. is devoted to Wounds of the Chest and Abdomen. To check hæmorrhage from a wounded intercostal artery-a very fatal injury, generally due to gunshot, and always associated with comminuted rib-the fragments of bone should be removed, and the vessel if possible tied; or the rib may be encircled with a ligature passed by means of a needle devised by the author (Fig. 224), or the vessel may be compressed by the author's intercostal artery compressor (Fig. 225).

Professor Agnew, in our opinion, attaches too little importance to the exclusion of air from the pleural cavity in thoracentesis: he says nothing about the occasional accident of sudden death during its performance; and the plan of operating which he describes is not, we think, the best. Gunshot wounds of the bladder are said to be less mortal than others of this viscus. The statement that when life is prolonged beyond four or five days the rent is through the nonperitoneal area, is a little too sweeping; while the advice to make a free incision through the perineum and neck of the bladder in all cases of extra-peritoneal rupture, is not quite good practice or scientific teaching. What value would such an incision have over the mere retention of a catheter when the rupture is in the front wall near the fundus? Nothing is said about aspirating, draining, or washing out the peritoneal cavity after intra-peritoneal rupture.

The War of the Rebellion has furnished Professor Agnew with abundant material to introduce into these chapters on wounds of the great cavities.

Chapter V., on Wounds of the Extremities, is very short. The only thing requiring special notice is the statement that wounds of the palmar arch or of its branches form no exception to the general law to tie both ends of the divided vessel through the opening made by the vulnerating body.

In Chapter VI., on the Diseases of the Abdomen, we find gastrotomy spoken of as an unjustifiable procedure, but as the author refers to no case later than Maury's, published in 1870, it seems doubtful whether he has made this statement with or without the knowledge of Verneuil's and other recent successful cases. Laparotomy and enterotomy for intussusception and internal strangulation are recommended in certain cases, though offering but gloomy prospect; and colotomy is of course advised in obstructions of the large bowel, though in malignant stricture of the rectum it is to be only an extreme resort, while for non-malignant strictures the treatment is said to be dilatation and incision, and we find no mention of colotomy under any circumstances. This is not giving to colotomy the place it deserves, not only as a means of relief in even the less extreme stages of cancer,

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but as a means of cure in syphilitic strictures. Professor Agnew errs on the right side when he says the colon will be formed exactly in a line one inch posterior to the middle of the crest of the ilium, and that the surgeon should work backwards under the quadratus lumborum muscle. It is better to cut the edge of the muscle. We are glad to find him objecting to the distension of the rectum as a means of finding the bowel. The introduction of the hand into the rectum, as practised by Simon and others, is condemned as a rash and revolting practice. The objections to Amussat's method of reaching the colon in children with imperforate anus are considered well founded, and Littré's method is deemed preferable. Excision of the rectum for epithelial cancer of the anus is thought quite as promising as excision of the lip for cancer. The author thinks unfavourably of all the varieties of radical cure for hernia, and doubts if the surgeon is justified in employing either. He never opens the sac in operating for strangulated hernia unless absolutely compelled. Listerism does not seem to have led him as yet to the opinion that the peritoneal cavity can be opened without risk. "A conical compress laid over the navel," is unadvisedly, as we think, recommended for congenital umbilical hernia.

Chapter VII. treats of the Diseases and Injuries of the Bloodvessels, and Chapter VIII. of the Ligation of Arteries. It is here that one realises the force of the arguments which are used against an increase of text-books on surgery. We read through page after page, and find next to nothing which differs from what we have read in any one of half a dozen similar works, while many of the illustrations seem to have haunted us from our surgical cradles upwards. Not that we mean to say that these chapters are badly done; on the contrary, good sound anatomical knowledge is everywhere evinced.

We find that the views we have ourselves long entertained against the utility of operations for the cure of varix are here boldly declared. The author says, "I do not believe that any operation which has yet been devised for the radical cure of varices is entitled to professional confidence." Tufnell's plan of treating aneurism is strongly advocated, not only as a means of cure, but as an aid to compression. Manipulation "merits unqualified condemnation"; galvano-puncture is attended with uncertain and by no means permanently good results; whilst the introduction of coagulating substances into the sac ought "to be banished from surgical practice,” and the introduction of solid substances, such as iron wire or horsehair, offers no promise of any satisfactory results; indeed, the language employed on page 579 in reference to the last method is stronger than we care here to reproduce. Intra-cranial and intra-orbital aneurisms receive full attention.

We commend Chapter IX. strongly to the notice of dressers, house-surgeons, and teachers of bandaging and the application of surgical apparatus. It is abundantly illustrated, and the illustrations, many of which are not at all generally known, are well explained.

The tenth and last chapter (by far the longest in the volume) deals with "Injuries and Diseases of the Osseous System." It is evidently a favourite subject with the author, and his manner of handling it is one of the most striking features in the book. A large number of tables comprising 685 cases of ununited fractures not only illustrate every variety of treatment for the cure of non-union, but also give many interesting details in connexion with the whole subject of "pseudarthrosis." The information herein condensed is so great, and of such great importance to surgeons, that we welcome its publication in any form and in any surgical work, and therefore will not cavil at the impropriety of introducing such tables into a textbook for students. We notice that Professor Agnew does not hesitate to say that a fracture of the thigh-bone cured with one-half or three-quarters of an inch shortening is a good cure, and allows of no room for complaint. Ten pages are devoted to fracture of the patella-all kinds of treatment are described: Malgaigne's hooks are condemned; and too close a union of the fragments is regarded as a disadvantage on account of the great tendency to re-fracture. Impressed with such a view, it would be interesting to know what the author thinks of the heroic method lately practised of opening the joint to wire the fragments together. Diseases of bone are, in comparison with fractures, very briefly dealt with, occupying only 37 out of 324 pages. Necrosis without suppuration is barely mentioned; and osteitis deformans,

lately brought prominently before the profession in this country, is quite omitted. There are doubtless other omissions which would be detected by another eye or by our own on re-perusing the pages of this volume; there are, too, several typographical errors which will be certainly corrected in another edition; but, on the whole, we have nothing but praise for a work which not only expresses its author's own views in an unequivocal manner, but which also evinces wide practical experience, combined with a very extensive knowledge of the literature of his profession. We shall look with much interest for the second volume.

A Manual of Family Medicine for India. By W. J. MOORE, L.R.C.P.E., M.R.C.S., Deputy Surgeon-General H.M. Indian Medical Service. Published under the authority of the Government of India. Third Edition. London: J. and A. Churchill. Calcutta: Thacker, Spink, and Co. Pp. 714. Goodeve's Hints for the Management and Medical Treatment of Children in India. Seventh Edition, re-written by EDWARD A. BIRCH, M.D., F.R.C.S., etc., Surgeon-Major, Bengal Establishment. Calcutta: Thacker, Spink, and Co. London: W. Thacker and Co. Pp. 426. NEW editions of these two well-known works have recently appeared. They are both intended to supply in some measure the medical wants of our numerous countrymen in India who may be either far from professional help in emergencies of sickness or of accident, or destitute of medical advice regarding the proper management of their own health, and especially that of their children, in the trying climate of Hindostan. Although we are, as a rule, very much opposed to popular medical instruction, believing that the result is most frequently a minimum of serviceable knowledge along with a vast preponderance of what is but partial, misleading, and dangerous, yet the peculiar circumstances of many of our countrymen in India, together with the special and insidious dangers of its varying climate, fully justify the publication of a few trustworthy popular works to warn the unwary new-comer before it be too late of the dangers he has to encounter, and to give judicious counsel to solitary individuals and families who cannot enjoy the advantages of personal professional advice. Moreover, the two works before us are in themselves probably about the best examples of medical works written for non-professional readers. The style of each is simple, and as free as possible from technical expressions. The modes of treatment recommended are generally those most likely to yield good results in the hands of laymen; and throughout each volume the important fact is kept constantly before the mind of the reader, that the volume he is using is but a poor substitute for personal professional advice, for which it must be discarded whenever there is the opportunity. Written with such objects and in such a spirit these volumes cannot fail to be of the greatest service, and that they are appreciated is shown by the rapid appearance of successive editions, the second mentioned and older treatise having now reached the seventh edition. We would add that although they are specially written for lay readers, there are few young medical officers proceeding to India who would not receive several useful hints from these unpretentious volumes. But it is to parents or to the guardians of European children in India that they must be of pre-eminent service.

The Manual of Family Medicine was originally written in 1872, in competition for a prize offered by the Government of India for a treatise suited to the medical wants of nonprofessional persons in India. Deputy Surgeon-General Moore's compilation received that prize, and was forthwith printed for circulation by the authority of the Indian Government. A second edition was soon called for, in which the chief alteration was that the drugs and remedies suggested for use were restricted to those most readily procurable and least likely to do harm in the hands of laymen. The work has now reached the third edition, and has again received a careful revisal.

The first edition of the treatise by Dr. Goodeve appeared at a much earlier date. It has now reached the seventh edition, and has been almost entirely re-written in accordance with the most recent medical experience by Dr. Edward A. Birch, Surgeon-Major, Bengal Establishment. The volume treats of everything that concerns the whole management and medical treatment of European children in India, explaining when they ought to be sent home to Europe, as well as

how they may best avoid the evil influences of climate during their stay in India. Altogether the volume is a most complete one on the limited subject which it handles.

The Student's Guide to the Practice of Midwifery. By D. LLOYD ROBERTS, M.D., F.R.C.P. Lond., Physician to St. Mary's Hospital, Manchester, etc., etc. Second Edition. London: J. and A. Churchill. 1879. Pp. 346.

We have only to add to what we stated in noticing this book on its first appearance, that the second edition has not only been thoroughly revised, but considerably enlarged, and its value thereby increased.

GENERAL CORRESPONDENCE.

DISTINCTION BETWEEN TYPHUS AND TYPHOID

FEVERS.

LETTER FROM DR. A. P. STEWART.

[To the Editor of the Medical Times and Gazette.] SIB,-Having shown in my last letter that Dr. Perry did not recognise in dothinenteritis a specific exanthematous fever, and that the views held and taught by him were in other respects quite at variance with those set forth by me in 1840, and now generally accepted as true, I should not have considered it necessary to say a single word in reply to his son's letter in your issue of December 27 had he not spoken of "what Dr. Stewart claims now as his discovery." I now claim only what has been for thirty-nine years allowed, and is now for the first time disputed-that I was the first on this side the Atlantic who made out and made clear the distinction between typhus and typhoid fevers.

I am, &c., A. P. STEWART. Grosvenor-street, W., December 30, 1879.

COLOUR-BLINDNESS.

LETTER FROM DR. B. JOY JEFFRIES.

[To the Editor of the Medical Times and Gazette.] SIR,-In your number 1526 you make editorial mention of the Parliamentary paper of August 5, 1879, in relation to examinations of masters and mates for colour-blindness.

In noticing the small percentage found you do not take into account the method of testing, which was by asking the candidates the names of the colour of pieces of glass and cardboard. I have dwelt, in my volume sent you last summer, on this point. On page 115 of my book I quote from Professor Helmholtz's "Physiological Optics," page 299, 1867, thus: "As to the examination of the colour-blind, simply asking them to name this or that colour will naturally elicit but very little, since they are then forced to apply the system of names adapted to normal perception to their own perception, for which it is not adapted. It is not only not adapted, because it contains too many names, but, in the series of spectral colours, we designate differences of tone as such, which to the colour-blind are only variations of saturation or luminosity. It is more than doubtful whether what they call yellow and blue correspond to our yellow and blue."

In the portion of Professor Holmgren's book which I give in my volume the uselessness of asking colour-names to detect colour-blindness is most admirably put. His very simple and sure method of testing, advocated by me, and now carried out by me in over 24,000 examinations, is already adopted in the United States Army, Navy, and Marine Hospital Service. I am, &c., B. JOY JEFFRIES, M.D.

15, Chestnut-street, Beacon-hill, Boston, Mass., U.S., December 12, 1879.

THE MEDICAL OFFICER'S STETHOSCOPE. LETTER FROM DR. H. VEALE.

[To the Editor of the Medical Times and Gazette.] SIR, A great authority on auscultation has remarked that a new stethoscope requires to be tried on as carefully as a new hat. The reason for this is clear. Some men hear best with a concave ear-piece, others prefer a flat or slightly convex one, but all seem agreed that the ear-piece, whatever may be