Case 21.-Female, aged 8 months. Needle operation. Result: A clear central pupil. Vision perfect. Two operations were required. Case 22.-Female, aged 8 years. Right eye. Needle operation. Result: A clear central pupil. Vision perfect. (a) One operation only.

Case 23.-Female, aged 8 years. Left eye. Needle operation. Result: A clear central pupil. (a) Vision perfect. Case 24.-Male, aged 3 years. Needle operation. Result: A clear central pupil. Vision perfect. Required several operations and renewal of opaque capsule. Case 25.-Male, aged 3 years. Needle operation. Iritis blocked up the pupil. (Left eye of above: Calcareous matter in lens. Good eye for artificial pupil).

GUNNER CHARLES A., aged 20, a black-haired, high-coloured, fairly-developed Cockney waiter; out of three years' service has spent the last in India. At the age of twelve was laid up three months with scarlet fever; otherwise healthy. Only three times in hospital last year, for a total period of fifteen days' with ague.

On Monday, February 23, did not feel very well; took a cup of tea in bed. Arose at 6.30, went to stables, then to parade, where he felt fever coming on as he was galloping. Whilst dismounting at the word of command all but fainting; he fancied his bowels twisted. At 10.30 sent off to hospital; there treated, the symptoms pointing to ague of daily acquaintDiaphoretic mixture given, cold applied to head, a Dover's powder ordered at night, to be followed by quinine in

ance.

the morning, when he appeared no better. Pain in the bagk about the sacrum, slight ochrey diarrhoea, tremulous dirty tongue, cold wrist, slow feeble pulse, gurgling in right iliac fossa, nausea, pain over the abdomen generally, also the fact of such complaint being about,-all led to the diagnosis of enteric fever.

February 25.-Is at once removed to a separate ward, and particular directions given about the disinfection of excreta. A medical subordinate in attendance; also a European nurse, as the patient loathes the native, and is ignorant of the language; also certain foods are to be sent for from the Artillery mess as required. Four leeches applied to abdomen, a dose of castor oil given; and, remembering the history of scarlet fever, I leeched his hot throbbing temples, shaved his head, and had cold lotions constantly applied; low milk diet.

26th. Bad night; tongue creamy; skin dry; pulse 90; temperature, 100° morning, 102° at night, 101° last evening; four watery evacuations; urine turbid, 1020; headache and lumbar pain both increased. Diaphoretics; abdominal poultices; chloral gr. xx.

27th.-Worse; three evacuations; tongue drier; pulse 120; respiration laboured; temperature 100-6° to 103.2°; thirst increasing. Barley-water and lime-juice.

28th.-Worse; bad night; dilated pupils; olive flush of face; five evacuations; flatulent; tongue quivering; epistaxis; constant bilious vomiting; increased gurgling. Dilute nitrohydrochloric acid in Mxv. doses yesterday and to-day, changed for bromide of potassium in scruple doses, changed again for chloral; temperature 101° to 104°, and late at night 105°; slight meteorism.

March 1.-A cool morning-temperature of the ward 68°. No better; seventh day of treatment; delirious; drowsy; bedclothes-picking; five dark slimy motions; tongue drier and more coated; skin harsh, pungent; pulse 94, feeble; loud râles heard over left lung; temperature 103 4° to 104.2°; urine more turbid, but to my surprise free from albumen; sordes; epistaxis; vomiting of undigested food, fortunately stopped by a scruple of bicarbonate of potash in hot water, when effervescents containing prussic acid did no good; opiate suppositories. Turpentine to chest; also poultices containing opium, aconite, and belladonna bandaged over the bowels; four ounces of port wine and four ounces of brandy added to egg-flip; specific gravity and quality of the milk to be carefully watched.

2nd. No better; increasing sordes; vomiting if he turns on right side; both knees painful; spleen tender; every symptom unsatisfactory. After the body was sponged he broke out into profuse perspiration. Temperature 100-4° to 101°.

3rd. Slept better; looks drowsy; tongue brown and dry; râles continue; pulse 68 morning, 70 at night; temperature 100°; agonising sciatica. Noticed a few rose-coloured pimples, subsiding on pressure, on the chest. Great debility; craving for food. Iodine applied to chest; bowels still packed; cold applied to head; soothing liniments over the buttock. Milk-diet, eggs, Madeira; careful nursing; liquid food; the repair of waste, anything to gain time, our tactics; no medicine.

4th.-Tenth day of treatment. Bowels quiet; pulse 62, feeble; heart's action extremely weak; no medicine; brandy three ounces; stimulating liniments over the spine. Attendants warned that the patient may suddenly die if raised in bed.

5th.-Temperature fell to 99° to 100° yesterday; reads today 97-2° to 100° in evening; the bowels act, the evacuations brown; urine always turbid. Quinine five grains; milk, eggs, cocoa, three ounces of brandy. Pulse 50 to 64 in evening.

6th.-Pulse 42 to 68; temperature 97° to 98°; tongue tipped with red, yellow centre, deeply fissured; râles subsiding; urine 1016, clearer; lies low, very feeble. Chlorate of potash, with tinct. ferri sesquichlor. in small doses; also a teaspoonful of cod-liver oil, brandy four ounces. Sinapisms applied to præcordial region.

7th.-Unusual weakness of the cardiac systole, left radial pulse inclined to intermit. Doubtless there is a clot which, acting as a plug, may cause sudden death, else paralysis with aphasia.

Condensing notes, it may be stated that the temperature afterwards became steady, sometimes 96° in the morning, occasionally 99 in the evening; face either flushed or sallow; slept well; evacuations gradually became solid; meteoric tendency subsided; urine continued turbid; sordes cleared off; tongue cleaned; the pulse lost its intermittent character, but in the morning registered from 42 to 48, the evening from 56 to 64, gradually improving until March 10, when the patient

sits up, and afterwards the morning range as well as the evening became satisfactory-for instance, 80. Nitro-hydrochloric acid and chiretta, quinine in five-grain doses occasionally, chlorate of potash, were the medicines employed.

About March 10 he had chicken-broth, cocoa, eggs, two glasses of Madeira; a few days after, fish diet, and a pint of beer the last thing at night, when he slept splendidly.

18th. After twenty-four days' treatment, progressing favourably, though the tongue continues dry, bowels gently open, slight pain over the abdomen of cutting character; is up several hours playing cards or reading; no medicine, but the bowels are well bandaged, and the patient is very careful in all things.

21st.-Enjoys a drive.

23rd.-Proceeds by train to Umballa, whence, on a stretcher, he will be conveyed to Kussowlee, a hill station where boys in a short time are transformed into splendid men. The effect is so astounding that medical officers fail to recognise in the lusty soldier the weedy lad sent there last year. If this patient has a good helmet and a jacket loose about the neck, keeps temperate, and avoids syphilis, his future may be long and prosperous. Failing in any of the above conditions, the heart will fail also. Cool weather, a good medical sub., a kind comrade, good food, and-last, but not least— the celebrated Madeira, pulled this case through. Some time or other I hope to write on the cause, prevention, and cure of enteric fever, the special disease of India annually attacking the young new-comers with increasing malignancy; to-day I would only concur in the opinion that the disease is due to climate, may originate spontaneously, and, though encouraged by bad water or fæcal exhalations, these are secondary auxiliaries of pestilence. One case starts others. Children are not specially affected; and menstruation, clothing, and in-door life protect women, who, however, after menorrhagia or hæmorrhagic labours are susceptible. The congested liver cannot neutralise the poison nor arrest putrefaction; the blood becomes poisoned too; the weak points, whether in heart, lung, brain, or kidney, go to the wall; and the delicate vascular glands of the lower portion of the ileum run on to gangrene.

Out of

The same poison may induce dysentery or originate hepatic abscess, and curiously enough rheumatic fever. fourteen cases not long ago treated, twelve were gunners to two drivers, nine were fair to five dark, nine came from a barrack with single verandah to five from double verandahs; lads working in forges specially liable. In hot weather cases die with rapidity compared to the cool season, when the most desperate may recover. When one case occurs, isolate him and prepare for the worst. Leeches to the bowels, mercurial ointment, castor oil, quinine, ipecacuanha, poultices and blisters for the bowels, ice for the shaved head, good nurse, good milk, good wine, figure in the list of remedies. Quinine may do harm; nitro-hydrochloric acid is very valuable sometimes, so is acetate of lead. Some medical officers are in favour of cold affusion, to which, I believe, Dr. Murchison objects, and his opinion is the most desirable. Dr. Harley has elaborately pointed out the identity of enteric with scarlet fever; why not include erysipelas, diphtheria, and puerperal fever? Still there must be a great difference, otherwise all the children would be down with scarlet fever, which as yet is unknown at Meerut, though lately prevalent at Umballa. However, as said before, the intention is to write at length on enteric fever if no epidemic here upsets all arrangements.

MADAME CHRISTINE NILSSON.-This distinguished artist has handed over a cheque for £942 to the treasurer of the Training School and Home for Nurses in connexion with the Westminster Hospital. In September next she will sing at Norwich on behalf of the Jenny Lind Infirmary.

INSANITY AND INTEMPERANCE.-The Commissioners in Lunacy for Scotland report that in the year 1873 the causes of insanity were specified on 615 admissions of patients into lunatic asylums, and that in 149 of these cases, or nearly a fourth, the admission papers stated that the insanity resulted from intemperance. The Commissioners add :-" It is possible that prolonged compulsory abstinence from alcoholic liquors may restore to habitual drunkards the power of self-control, and enable them to resist the craving to which, when at liberty, they succumb; but our own experience does not give us much reason to expect this result."

REPORTS OF HOSPITAL PRACTICE

IN

MEDICINE AND SURGERY.

LONDON HOSPITAL.

A SERIES OF

CASES ILLUSTRATIVE OF CEREBRAL PATHOLOGY: CASES OF INTRACRANIAL TUMOUR. (Under the care of Dr. HUGHLINGS-JACKSON.)

(Continued from page 235, vol. i. 1874.)

Case 13.-Syphilitic Tumour of the Middle Lobe of the Cerebellum. In this case the diagnosis of intracranial syphilis was made on the patient's first admission into the hospital by the fact that there were the remains of bygone iritis. (There was no history of primary syphilis.) There was no possibility of making that diagnosis except by such direct evidence. In some cases we can make the diagnosis of intracranial syphilis by indirect evidence. In some cases the random arrangement and succession of the nervous symptoms justify that diagnosis. But this man had only the symptoms which an adventitious product of any kind will cause. Indeed, I was not absolutely certain that the intracranial disease was syphilitic. I was the less certain the nearer the patient's death, because his nervous symptoms were of exactly the kind producible by a glioma or other limited adventitious product, and not of the kind most often produced by syphilis. It is true that syphilis does sometimes, as it did here, imitate, so to speak, a glioma. There may be but one distinct syphilitic mass, and not a random affection of parts here and there, as there usually is in syphilis. As the patient had had earache there was the possibility (or rather, I should say, the improbability) of cerebral or cerebellar abscess to be considered. Had there been no iritis the diagnosis of syphilis could not have been made in this case.

The diagnosis of the position of the disease could not have been entered upon until the reeling began. But, as I say in the report, the expression "reeling "is an exaggeration; the difficulty of walking was trifling. I did not venture on a diagnosis of the position of the tumour. A marked reeling, however, is very characteristic of disease of the cerebellum. I believe that it is the result of paresis of the muscles of the spine.

The increase of fluid in the lateral ventricles of the cerebrum was probably the result of pressure on the veins of Galen. There was a mechanically caused dropsy of the ventricles, analogous to ascites, from tumour compressing the portal vein. There was, however, not an excessive quantity of fluid, as there is occasionally in the lateral ventricles of children who die from the effects of tumour of the middle lobe of the cerebellum.

A man thirty-four years of age was admitted on June 17, 1872, and came under my care on August 5, 1872. This was his second admission.

History. He had never had any illness before the one of which he died, except that he had once had gonorrhoea (no sore throat, no rash), that he had had earache of the left ear (vide infra), and that he had had pains in his limbs. In November, 1871, he was taken suddenly with pain in the left ear, and he felt so stupid that he could not stand up by himself. (Possibly these symptoms were owing to disturbance of the semicircular canals.) He tried to go on with his work, but had to give up, and went to the infirmary. He got worse, suffered severe pain, nearly always at the back of the head, had constant vomiting and retching, and his sight began to fail. He then left the hospital and came by sea (from the North of England) to London, and was for the first time admitted as an in-patient of the London Hospital. He had then double optic neuritis. There were pigment stains on the capsules of the lenses, and from this the inference of past iritis was drawn, and the diagnosis of intracranial syphilis was made. There was no defect of sight. He went out much better, but soon got worse again, and was readmitted June 17, 1872. He had the same symptoms as before-pain in the head, vomiting, and there was a later stage of the neuritis. He was not thin; he gained weight in the hospital. On October 29 he weighed 129 pounds, and on January 3 following, 140 lbs. He did not look ill. I not known that he had double optic neuritis, I should

Had

have thought he was malingering, and even knowing-being certain that he had that nervous symptom-I did think that he exaggerated his condition in order to stay in the hospital. It is to be observed that to an ordinary observer there was no defect of sight; he could, however, read only No. 3 of Snellen (he did so four days before his death). It is to be particularly noted also that there was no deafness; each ear was carefully tested. Again, six weeks before his death, his senses of smell and taste were carefully tested, and were believed to be good. The signs of past iritis, of course, persisted. The pain in the head was severe; the vomiting frequently urgent. He kept his bed mostly until his death, because he could there easily adjust the ice-bag for the relief of his pain. He had only two new symptoms before he died. In October he had delusions-e.g., he believed that he had been out to the “barrack yard," whereas he had not left the hospital. This state of things soon passed off, and throughout kis illness, with this exception, his mind was clear. The other additional symptom was only noticed about a fortnight before his death. He walked badly. There was a slight reel; it was exceedingly slight. He walked with his legs a little apart, and swayed a trifle now and then. In fact, this description is almost an exaggeration, but it is important to mention the slight difficulty, as we found disease of the cerebellum.

The patient died unexpectedly on January 22. As remarked, he suffered all along from severe pain in his head. Besides the iodide and bromide, I had tried blisters, a seton, doses of chloral, and a few days before his death, as the pain was intense, I ordered a few leeches. This last application was simply to relieve the intense pain, and is particularly mentioned to show that his pain, always bad, was unusually bad shortly before his death. The morning of his death he had not only the pain, but he vomited incessantly. He would not let the nurse leave him. At ten o'clock he suddenly raised himself up; his head fell on the nurse's arm, and then he fell back dead.

Autopsy. There was no disease anywhere except in the encephalon and in the liver. (The testes, unfortunately, were not examined.) In the liver there was near the outer edge of the right lobe a gummatous tumour the size of a hazel-nut. The cerebrum was quite healthy, except that the convolutions were much flattened, and the lateral ventricles distended with fluid. On the posterior inferior surface of the left lobe of the cerebellum, glueing the cerebellum and its pia mater to the dura mater, were one or two small masses, none larger than a split pea. The principal disease was a tumour about the size of a hazel-nut, evidently syphilitic, in the posterior and inferior part of the middle lobe of the cerebellum.

4441

ST. THOMAS'S HOSPITAL.

DOUBLE CANCER OF MALE BREAST-REMOVAL OF BOTH BREASTS-RECOVERY. (Under the care of Mr. WAGSTAFFE.)

THE extreme rarity of the occurrence of cancer in the male breast makes the following case one of very great interest. A peculiar feature is that both breasts were affected, and we know of no similar case being on record :

W. P., aged 61, well developed and well nourished, a blackemith by trade, was admitted into St. Thomas's Hospital on March 20, under the care of Mr. Wagstaffe, with well-marked scirrhus of both breasts. Eighteen months before he had noticed a lump in the left breast; this had grown slowly, but without pain, until August last, when it began to be slightly painful; for the last month it had been troublesome, worrying the man with shooting pains, and preventing him from using his left arm. The lump in the right breast had been noticed three months, and was comparatively painless. When sent up for examination, there was a lump in the left breast, involving the skin to a certain extent-that is to say, the skin was red, thin, and adherent. Below and to the outer side of the nipple the growth projected as a smooth, hard, semi-elastic, oval mass, about two inches in its transverse diameter, somewhat nodulated towards the nipple, which was retracted. In the right breast nothing could be seen, but a small scirrhous nodule could be distinctly felt under the nipple; it was not, however, well defined. In neither case was the surface broken, nor was there any discharge from the nipple. There was some doubt about the condition of the axillary glands on the left side, but no distinct enlargement could be made out.

30th.-Temperature 992. Wounds closed with strapping. After this the wounds closed rapidly. On April 29 he went away to the seaside without any induration remaining in the wounds, which had healed, or in either axilla. When last seen (May 22), there was no evidence of return of the disease.

Remarks. It is surprising that cancer does not appear more frequently in the male breast, if cancer by preference attacks organs and tissues undeveloped and retrograde; but the number of cases recorded is peculiarly small. It is more surprising that in this case both breasts have been affected without any evidence of universal dissemination or constitutional disease, for no trace is to be found of cancer in other parts; not even lymphatic glands seem to be affected. On searching carefully into the family history, there seems to be no indication of any members of the family having been affected with cancer; and on inquiring into the possibility of local causation, there seems to be very little to help one there, for though he has used his chest a good deal for pressing on a centre-bit, the breasts have not been the parts most pressed upon, but the sternum. Friction of the breast by his shirt has never been enough to cause obvious irritation of the breast. The naked-eye appearances and microscopic examination of the growths show them to be typical scirrhus.

LEEDS GENERAL INFIRMARY.

DEATH FROM CHLOROFORM.

(Under the care of Mr. JESSOP.
[Reported by Mr. TICKLES.]

GEORGE W., aged 48, a strong, healthy-looking man, by occupation a joiner, who was described as a drunkard and a passionate man, was admitted into the Leeds General Infirmary on July 15, 1874, suffering from destructive inflammation of the middlejoint of the third finger of the right hand, caused by his striking a comrade in a quarrel.

On Thursday, July 16, he was brought into the operating theatre for the purpose of having his finger amputated, and at his own request chloroform was administered. The chloroform was administered by the House-Physician in the usual way-on a piece of lint, and from a bottle with a drop cork. He took it rather badly, struggled more than is usual, and was fully under the influence of chloroform, not having taken more than two fluid drachms, when he gave two or three snorts, suddenly became livid in the face, his respiration stopped, and his pulse became faint at the wrist. Artificial respiration was at once commenced by the Sylvester method, and was continued for an hour, together with cold affusion to the face and chest, galvanism to the heart and diaphragm, and ammonia to the nostrils. The heart was heard to beat faintly at the end of about twenty minutes; after that time no sound could be detected, and no attempt was at any time made by the patient at voluntary respiration.

Post-mortem examination was made twenty-two hours after death. The brain was found healthy. The lungs were somewhat congested. The heart was flabby and slightly enlarged, weighing twelve ounces and a half; both ventricles contained a little fluid blood; valves healthy. The abdominal organs were generally congested, otherwise healthy. The stomach was perfectly empty

This is the first death which has occurred during the administration of chloroform since the opening of the new Infirmary in 1869.

THE deaths in the eight principal towns of Scotland for the week ending the 25th ult. were 643. For the corr sponding week of 1873 they were 629.

BURIAL AND NO BURIAL.

IN a late article referring to Bishop Wordsworth's assault on the proposal to substitute "Cremation" for "Inhumation," we took occasion to say that the advocates of burial, amongst whom we rank ourselves, should, in all candour, admit and endeavour to remedy the evils of the system as at present in use. We are quite sensible of the enormous change for the better, in the substitution of the suburban cemetery for the town churchyard-the open, cheerful flower-garden for the noisome churchyard where weeds scarcely found time to grow; but the suburban cemeteries are prone to evils which will increase as time goes on, but which may be prevented if the public will accept a humble, common-place view of the true objects of burial.

There are two main theories, one of which has influenced humanity at large, and the other more especially the Christian community. One is the determination to evade the common fate of humanity, to resist the sentence of "dust to dust," to refuse to mingle one's remains with those of the vulgar. To this very natural feeling Christianity has added the desire that the mortal body shall continue undisturbed in consecrated ground until the Resurrection Day. Under the combined influence of these-very natural and laudable-feelings, they who make provision for the disposal of their own remains, or of their friends', forgetting the instability of all human affairs, take measures which defeat the very object in view. If it be an indignity to have one's bones lying unburied, then surely those persons are to be envied who are buried deep in nameless graves and allowed to moulder undisturbed. But the occupants of conspicuous tombs are sure to be dislodged, and their bones scattered about by the irreverence, the curiosity, or the malice of succeeding generations. As for the proud Egyptian monarchs, we have their mummies and tombs in our museums. It is the piety of Mussulmans which has prevented the tomb of Abraham at Macpelah from desecration. A sarcophagus, said to be of King David, is in the Louvre.

The bones of the Anglo-Saxon kings were tossed out of their sepulchres by the Parliamentary soldiers in the Great Rebellion, and are now promiscuously preserved in chests in Winchester Cathedral. The tomb of William Rufus, in the same Cathedral, was ejected from a place it had held for seven centuries, and its contents dispersed within these few years. The Gentleman's Magazine of the last century tells how the tombs of the Plantagenet Kings in Edward the Confessor's Chapel were opened to gratify a morbid curiosity. That King Charles the First's coffin was opened, and a portion taken away of the vertebra which had been severed by the axe, is well known. The remains of King James the Second were dragged from their tomb at St. Germain's during the French Revolution; so well preserved were they that the fingers were quite flexible. "Murray's Guide Book for Egypt" relates the horrible medley of arms, legs, and skulls of mummies, resulting from the digging out the cemeteries at Sakkara in search of antiquities. In fact, all experience shows that attempts to defeat the law, "dust to dust," are punished by an aggravated though later form of degradation.

Burial, as one of the seven corporal acts of mercy, is intended to hide the shame of the grotesque, disgusting condition of the body during its decay; but if artificial means be taken to avert decay, it only secures to the departed the degradation of being exhibited in a glass case in the museums of some other quarter of the globe. The very changes on the earth's surface, the washing away of churchyards by the sea or rivers (as at Reculvers), the decay of buildings and removal of tombs, the construction of roads, and the like, not to say popular revolutions, religious and secular, in which coffins are turned into bullets and bells into cannon- -all these things render nugatory the hope of avoiding the mingling of dust with dust.

With ideas like these, we see with dismay the artifices exhibited in the suburban cemeteries for insuring future desecration of the dead by means intended to avoid the fate of mortality. In some of these cemeteries may be seen structures marked out as the prey of future spoilers, delicate chapels of marble, with plate-glass windows, exhibiting the highly polished oaken coffin with its gilded ornaments. How long is this to remain unviolated? One century, two, or three? Be it so; but the time will come when the occupants will be forgotten, when a future generation will dispute the right of tying up land in perpetuity for a tomb, and when the remains will be carted off with little enough of reverence.

So far we have argued on the ground of common sense against artificial means of preserving bodies from decay, against metallic coffins, against tombs and mausoleums intended to prevent the dead from being mingled with their kindred dust. But there is one argument more. The unburied coffins containing half-decomposed bodies which fill the socalled catacombs of the cemeteries, are eminently unsafe to the visitors who resort to these cemeteries to pay their respects to the dead, or to seek a little fresh air in their wellkept walks and shrubberies. A friend of ours who visited one of these places lately asked one of the gravediggers if the "brick graves" were not offensive at times. "No, sir," was the reply, "it isn't them; it's the coffins as leaks in the catacombs." "Some of them," said another, are a good deal blown." We need say no more, except to quote the Patriarch Abraham and his desire to have "the dead buried out of his sight," not left to moulder in a cellar exposed to the eyes and noses of posterity.

GENERAL MEDICAL COUNCIL. In our comments on the late session of the General Medical Council we left unnoticed one subject which excited a good deal of discussion. In the second report on the medical

examinations in the Queen's University, Ireland, the visitors make the following statement:-"We think it right to say that, in the course of our visit, we ascertained that it is a common practice for candidates rejected at the M.D. examination of the Queen's University to present themselves at the next ensuing examination of one of the Scottish licensing bodies, and to obtain therefrom a licence to practise almost immediately after previous examiners had declared them to be unfit. This practice, which is not limited to rejected candidates of the Queen's University and successful aspirants for Scottish licences, is, to say the least, exceedingly reprehensible, and injurious to the profession, and ought to be suppressed. We would suggest that the evil might, to a large extent, be remedied by a regulation of the Medical Council to the effect that no rejected candidate for a degree or other licence to practise should be permitted to present himself for examination before any licensing body within at least six months after his rejection." This was more than once commented on with not a little warmth, and Dr. Bennett, one of the visitors, was several times challenged to produce the authorities for such a statement, but he persistently declined the challenge, and it is easy to imagine that it would not have been fair to his informants to mention their names-not, at any rate, without their express permission. But the statement seems to imply that the examinations by the Scottish licensing bodies were easier to pass than the examinations at which candidates had just previously failed; and, naturally, this was indignantly repudiated by the representatives of the Scottish bodies. Dr. Fleming observed that it "was true that the Scotch bodies had a large number of candidates from both England and Ireland, and when a man presented himself he was subjected to a thorough and searching examination"; and he showed that out of fifty-nine Irish candidates who had presented themselves at Glasgow during the last six years and a half, twenty-one had passed, and thirty-eight had been rejected. "Four of those rejected had previously passed the first examination of the Queen's University, and sixteen held Irish diplomas; therefore it was perfectly evident that the Glasgow standard was higher than that of the Irish bodies." And Dr. Andrew Wood repudiated the implied stigma on the Scotch bodies, and "challenged the most minute investigation."

During one of the discussions, or conversations, on the subject, Dr. Parkes agreed with the opinion, expressed in the visitors' report, that no man rejected by one body should be allowed to go up to another licensing body until a certain time had passed. But the President pointed out that the matter had some time since been debated in the Council, and it was felt that it would be rather like gibbeting a man to send his name to all the other bodies; and Dr. Storrar added that "it was then the opinion of the Council that if a man presented himself before a certain body for examination, having complied with all the previous conditions of the examination, it was for that body to determine for itself whether the candidate was qualified, and that it ought not, in fact, to be guided by any conduct on the part of another body." The outcome of these discussions was that Dr. Bennett withdrew a motion he had placed on the notice paper, embodying the suggestion of the visitors, feeling that the matter had been sufficiently discussed. It was rather a mistake, we venture to think, to bring the subject to the notice of the Council without producible proof of the statement made, and something like proof that by the practice alluded to imperfectly qualified men gained admittance to the profession. It may be "a matter of common belief" that men rejected by one licensing board go at once to another, and sometimes with success; but ought "common belief" to move the Council to action? And supposing it proved that the practice denounced in the visitors' report does obtain, is it an evil that "ought to be suppressed"? We do not see that it is, unless it be admitted

that some of the examinations for licences to practise are of such a low standard that men unfit to practise can pass them. And in that case the Council would, of course, exercise their power of, by aid of the Privy Council, closing such portals to the profession till the sinning bodies had amended their ways. It may surely, however, be taken for granted, at this date of the Council's existence, that all examinations for a diploma or licence are tolerably fair and up to mark; and in that case where is the injury to the profession if a candidate, failing to pass one examining board, goes immediately to another?

Grant that no licensing body will admit a candidate into the profession unless he has passed such an examination as is a good and fair test of his fitness to practise-and it is the work of the Council to see that this is the case,-and we fail to see that it can be injurious to the profession or the public if a candidate gains a licence from body 4, or 7, or 17 immediately or very shortly after having failed to get it from body 3 or 9. On the other hand, the possibility of "trying again" may be everything to the candidate, and is a great deal if it only saves him a delay of three or six months. There is a great deal of human nature in both examiners and candidates; the former may have crotchets or may have tempers; and the latter may be exceptionally nervous, or temporarily indisposed or unready. It is not quite an unknown thing for a really "good" and well-prepared candidate to fail now and then from these and somewhat similar causes, we believe; and the misfortune, or unintentional injustice, may be remedied by his presenting himself before another examining board. So long as there are several examining bodies, we do not see why a candidate who has failed to pass one of them should not have the power of submitting himself for examination by a second; and we do not see that that power can be mischievous so long as the Medical Council takes care, through "visitations" and the other means within its powers, to see that the requirements and examinations of no licensing body fall below a certain standard. If it is known that all the examinations are about equally stringent, fair, and good, no ill-prepared student will travel about from one examining body to another in hope of snatching a diploma.

MURDER BY CLUB RULE. "MOTHER-OF-PEARL" is a well-known substance turned largely to useful and ornamental purposes, and the principal seat of its manufacture is Birmingham. In the processes of cutting the shells and of making buttons, much dust is evolved as a matter of course, and the dust, being a mineral-and a highly irritating one, by reason of its vitreous hardness and mode of fracture-proves especially obnoxious to the lungs when inhaled, and produces that particular and too well-known form of phthisis induced by the mechanical irritant action of mineral particles on the pulmonary tissue, as exemplified so fatally among Sheffield grinders and among potters.

The law of self-preservation is much insisted upon by philosophers as an inherent and valuable appanage of human beings; but, unluckily, as experience among workpeople of various sorts shows us, the beneficial operation of this law is more or less neutralised by what may be called another law-viz., that of indifference. Philosophers speculating on human actions in their closets, keeping before them ideal men, as well represented by their own philosophic selves, fall into great errors respecting the motives and modes of action of living men, and particularly of that medley of beings who assume to themselves the special appellation of "the working classes.” The love of life, or the law of self-preservation, should, on philosophic principles, dictate the avoidance of all causes of disease and of death; but this natural course is seen to be departed from on all sides, under the influence of the passions and the lusts of the flesh-or, in more modern phraseology,