the press, the report concluded as follows:-" In conclusion, your Committee will only add that, while the experience of another year has shown more clearly than before the enormous magnitude of the work which the Association has undertaken, and of the difficulties which lie in the way of its accomplishment, it has also more fully convinced them that, with adequate support and encouragement, much permanent good may be achieved, and for that encouragement and support they look confidently to the members of the Association and the public." The President of the King and Queen's College of Physicians, in moving the adoption of the report, observed that the Association, although a voluntary body, without legal powers or public funds, was from its scientific character an efficient aid to the Public Health Committee. Dublin was much more unhealthy than London, Edinburgh, and other large cities, although it possessed wide streets, easy access to the country, pure air, and plenty of good water, and it ought to have a salubrious stream passing through it. Besides defective sanitation, the vice of intemperance had much to say to the unhealthiness of the city. Mr. Robert O'B. Furlong, barrister-at-law, seconded the motion, and pointed out that the cleansing of the ashpits of the tenement houses in Dublin alone at the rates laid down by the authorities would bring in £32,400 per annum! He referred at length to the efforts now being made in London by Miss Octavia Hill and other sanitarians to improve the dwellings of the humbler classes. The resolution was carried unanimously. Mr. Alexander Parker, one of the leading merchants of the city, proposed, and Mr. Thomas Pim, jun., also a merchant, seconded a motion-"That the following do constitute the officers and committee for the year 1874-75:-President: Jonathan Pim. Vice-Presidents: Sir Edward R. Borough, Bart., J.P., D.L.; Lord James W. Butler; Fleetwood Churchill, M.D., chairman of Executive Committee; Sir Arthur E. Guinness, Bart., J.P., M.P.; Ion Trant Hamilton, M.P., D.L.; the Right Hon. Viscount Monck, G.C.M.G.; George H. Porter, M.D., F.R.C.S.I., Surgeon in Ordinary to the Queen in Ireland; the President of the King and Queen's College of Physicians, Ireland; the President of the Royal College of Surgeons, Ireland; William Stokes, M.D., F.R.S., etc., Physician in Ordinary to the Queen in Ireland, and Regius Professor of Physic in the University of Dublin; Lord Talbot de Malahide; Colonel the Right Hon. T. E. Taylor, M.P. Executive Committee: E. F. Beatty; Rev. F. F. Carmichael, M.A.; C. P. Cotton, C.E.; Thomas Drew, R.H.A.; J. M. Finny, M.D.; Thomas W. Grimshaw, M.D.; Rev. Alfred Harvey, M.A.; Thomas Hayden, F.K.Q.C.P.I.; Rev. Morgan W. Jellett, LL.D.; Joseph E. Kenny, M.D.; J. J. Digges La Touche; John M'Evoy ; J. W. Moore, M.D.; D. Toler T. Maunsell, M.B.; Geo. R. Price; Thos. Purcell, L.K.Q.C.P.I.; Robert Sexton; Abraham Shackleton; Albert O. Speedy, L.R.C.S.I.; H. H. Stewart, M.D., F.R.C.S.I.; Rev. Robert Walsh, M.A.; Rev. James Walshe, B.D.; W. Dudley White, L.R.C.S.I.; Wm. White, Sen. City Coroner. Hon. Treasurer: Wilfred Haughton, 28, City Quay. Hon. Secretaries : Robert O'B. Furlong; Chas. F. Moore, M.D., F.R.C.S.I.; John Todhunter, M.D.; Frederic W. Pim. Assistant-Secretary: Edward Spencer. Bankers: Messrs. Boyle, Low, Murray, and Co., 35, College-green." The resolution was put and carried nem.con. Dr. Grimshaw moved, and Mr. W. Haughton seconded, a vote of thanks to Dr. Churchill, chairman of the Executive Committee. This was carried by acclamation. Mr. Parker having taken the second chair, a vote of thanks to Mr. Jonathan Pim was proposed by Dr. Churchill, seconded by Dr. Evory Kennedy, and adopted by acclamation. The proceedings then terminated.

FROM ABROAD.

OBSTETRICAL ANESTHESIA.

PROFESSOR GUBLER, presenting a memoir to the Académie de Médecine upon this subject from Dr. Campbell, the wellknown obstetrician of Paris, drew an observation from Prof. Depaul, which we may notice. The purport of Dr. Campbell's memoir was to give an account of his experience in the administration of chloroform. He has, it seems, employed what he calls "obstetrical anesthesia" in 942 cases without having to regret the slightest accident; and he believes that the cause of such immunity is to be found in the efforts

rendered necessary for the expulsion of the infant and the cerebral hyperemia which necessarily accompanies these. Prof. Depaul observed that surgeons understand by the term anesthesia the absolute loss of movement, sensibility, and consciousness, which is determined by the administration of a more or less considerable quantity of chloroform or ether. But in none of Dr. Campbell's cases was this kind of anesthesia produced. He contented himself by giving very small doses of chloroform, by means of which a certain amount of insensibility was produced; and it would be an error to suppose that these 942 women have been subjected to anesthesia as generally understood with impunity. Accidents from the obstetrical administration of chloroform are not unknown, and M. Depaul is in possession of cases in which sudden death has been produced by it. He believes that great care is required in its administration, and that in cases of ordinary labour it can be very well dispensed with. Prof. Gubler, in reply, observed that in the immense majority of obstetrical cases there is no necessity to carry the anesthesia to absolute unconsciousness, it often sufficing to determine a slight insensibility in a nervous or pusillanimous woman to facilitate the process of parturition or to obviate certain inconveniences. Dr. Campbell has sought to produce a variable amount of anesthesia according to the case, and has almost always found that slight insensibility sufficient to which the name "obstetrical anesthesia" has been given in order to specify it.

(The mere smallness of the dose will not explain the immunity observed in the administration of chloroform to lying-in women, as it is well known that in many cases of death from chloroform this has ensued upon the inhalation of very small quantities of chloroform. The immunity reported by Dr. Campbell has been met with in the practice of all obstetricians; and we would suggest to Prof. Depaul that he would do a good service by publishing the details of the fatal cases which he says he is in possession of.)

PROFESSOR BERT'S REPORT ON THE NEW FACULTIES OF
MEDICINE.

Some time since the National Assembly appointed a Select Committee to consider the petitions addressed from Lyons, Bordeaux, Toulouse, Nantes, Lille, and Marseilles, praying that faculties of medicine might be instituted in these cities. M. Paul Bert was appointed the reporter of the Committee, and has drawn up an elaborate report on the subject, which is some two or three hundred pages in length, and lavishly furnished with shaded maps (exhibiting the proportion of practitioners,. students, etc., in the different departments) and copious statistical tables. Of so bulky a document we can only give a brief account, as also of some of the criticisms it has called forth.

In the first place, M. Bert commences by regretting that the Assembly has so limited the sphere of action of the Committee as to prevent its taking into consideration the faulty condition of the three faculties and twenty-two preparatory schools of medicine which now exist. These, according to his account, stand in need of radical reforms to save them from a continuance of the decay in their reputation which has set in. The Committee, however, confines itself to recommending that two new faculties should be created at Lyons and Bordeaux, upon the same plan as that of the existing faculties. This recommendation has been severely criticised by M. Latour in the Union Médicale, who maintains that there is no urgent need for the immediate creation of these faculties, and that the doing this should be postponed until the reorganisation of medical teaching, which cannot be long delayed, has been accomplished. Then will have to be determined the question of the acknowledgment of free teaching of medicine, independently of the faculties, which has many advocates. The accuracy

of one of M. Bert's strongest reasons for the increase in the number of the faculties-viz., the diminution in the number of practitioners, to the great detriment of several departments-is also denied by M. Latour. M. Bert brings forward a strong statistical array in proof of the number of practitioners having diminished or remained stationary; but M. Latour declares that there is no accurate account of the numbers of the profession in France in existence, these having been quite arbitrarily stated at 20,000, 18,000, or 16,000. Even taking M. Bert's figures (15,419) as correct-that is, one for every 2341 inhabitants,-when it is considered how many of these are relieved by charity and purloined by quacks, the proportion seems amply sufficient. It is true that these are very unequally distributed, and that in some departments.

there is a real paucity of properly qualified men. But this is because they are unable in these localities to make a satisfactory living. M. Paul Bert's specific for replenishing these departments, by forming new centres for the supply of doctors, is illusory in the extreme, for whencesoever they derive their degrees, practitioners will not consent, for example, to live in Brittany, where they are exposed to the tolerated competition of priests, religious houses, and charlatans of all kinds. A protective law against medical parasites would probably be a more effectual remedy. Another illusion entertained by M. Bert is, that on the creation of new faculties a considerable portion of the 4000 or 5000 students who now overcrowd the Paris Faculty, and render effectual demonstrative teaching impossible, will be diverted to these establishments. Paris will still continue to have, as it always has had, superior attractions for students, there can be little doubt. The teachings of experience favour this view; for of the eighteen faculties in existence during the ancien régime, two only (Paris and Montpellier) flourished, and that at a period when provincialism prevailed in great force, whereas at the present time the tendency is for Paris to absorb everything. Most persons are of opinion that to create a number of new faculties with power to grant degrees would be most mischievous, owing to an utter want of capable men to fill the professorships and to the deterioration of instruction likely to ensue. Many incline to the deprivation of the faculties of the power of licensing to practise, this being conferred on a body of State examiners.

That

In the meantime, M. Bert's proposition for the creation of the two new faculties has met with the approval of the Government and the Assembly, and the measure, if not impeded by the political imbroglio, will soon pass. All seem agreed that Lyons, at least, has pre-eminent claims in consequence of its great teaching capabilities.

ON THE EMPLOYMENT OF TRUSSES IN VARICOCELE. Ar a recent meeting of the Hufeland Society of Berlin, Dr. Ravoth read a paper (printed in the Berlin. Klin. Woch., May 11), upon the plan of treating varicocele by means of hernial trusses, which he has pursued for several years with great success. Twenty-eight cases so treated form the basis of the present communication.

Varicocele, as is well known, almost always occurs on the left side, and in the great majority of cases dates from the period of puberty-most cases, in fact, being made known during the examination of youths as recruits. It is very rare for it to appear after the twentieth year, and it usually undergoes any considerable increase after this time only in consequence of some irritation of the sexual apparatus. How little the venous stasis produced by hernia and trusses has to do with the production of the affection may be judged by the fact that in nearly fifteen hundred left inguinal hernias, which have come under the author's notice, he has never once met with a case of varicocele. Indeed, as among so many cases there must have been some instances of co-existing varicocele, these have, in fact, been cured by the application of the truss employed for the hernia. The chief causal condition in the production of varicocele is irritation of the sexual apparatus; but whether this is to be explained by an augmented accession of blood, with relaxation of the cremaster and the dartos, inducing dilatation of the spermatic veins, or by an enfeebled state of the trophic nerves, further investigation must decide. As a practical fact, it is to be observed that the application of the hernial bandage will ameliorate all cases of varicocele; and when these are recent or have become increased by accidental irritation it will cure them. During treatment the truss should be kept on permanently, except at night. During two or three hours daily, the compression of the pad is augmented by means of a supplementary spring. In two cases narrated the cure was effected in two and three months respectively. Under compression the varicocele immediately diminishes in size, and any pain that may be present disappears. The testis is also brought nearer the abdominal ring in consequence of the stimulation imparted to the cremaster.

Dr. Ravoth is of opinion that this mode of treatment may be advantageously applied for the relief of the varicose state of the lower extremity so frequently met with. Here, however, for prompt results, recent cases must be dealt with, as those which have lasted for years, and are attended with great thickening of the walls of the veins and degeneration of the surrounding connective tissue, can only be very slowly ameliorated. The pad should be applied to the femoral vein beneath Poupart's ligament, and especially where the saphena vein

enters it. Dr. Ravoth is also in great hopes of soon showing that this mode of treatment may be employed very advantageously in treating cases of onanism and pollution. These cases, of course, require a great deal of individualising and adaptation of treatment owing to their complicated character.

REVIEWS.

Untersuchungen über die Vegetationsformen von Coccobacteria
septica und den Antheil welchen sie an der Entstehung und
Von
Verbreitung der accidentellen Wundkrankheiten haben.
Dr. THEOD. BILLROTH, Professor, etc. Berlin: Bei George
Reimer. 1874.

Investigations on the Botanical Forms of Coccobacteria Septica and the Share which they have in the Origin and Spread of Accidental Surgical Diseases. By Dr. THEODORE BILLROTH, Professor, etc. Berlin: George Reimer. 1874. With Plates, quarto, pp. 240.

THIS great work is the result of five years' labour of a man whose name is amongst the foremost in science. The subject which it deals with is one of unusual interest at the present time, from its intimate connexion with some of the most urgent questions of pathology and the treatment of wounds. What is the cause of infection? What part do organisms play in it? These and similar questions are anxiously asked by every surgeon, and yet none of the answers which have been returned, is sufficiently satisfactory to settle the matter in any definite way. Quite the contrary is the case. The present

state of science shows that we have taken only the first steps towards a clear understanding of this subject. The work which we have now before us shows very clearly that we have not yet advanced far enough to hope for any speedy and definite solution of the problems of the nature of infection and the share taken in it by organisms. We must not be discouraged, however, by this state of matters, nor stop in the course of our investigations even when a new work calls in question the previous results. On the contrary, we ought to be thankful that we can now see defects and errors in the arguments where before we were not able to detect them, and we must acknowledge that things are much more complicated than we at first thought them to be. Instead of frequently employing mere words, such as "fermentation" and "putrefaction," we should possess an exact knowledge of every single chemical process belonging to the disintegration of organic matter; and we should know exactly all the botanical relations of the plants to which we ascribe the power of disintegration, before we attempt to study their life and influence on organic matter. There is no doubt that many of the former investigators of these questions somewhat neglected the preliminary conditions of their solution, eager as they were to obtain an important practical result, and it is therefore easy to understand why their conclusions cannot always stand severe criticism. The superiority of Billroth's work seems to us to lie in demanding greater exactness and clearness. It does not bring forward many surprising discoveries, but opens new views in the direction which must be taken in future researches of a similar kind.

In the first and purely botanical part of the work, Billroth gives a new description and classification of the different forms of coccos and bacteria. He divides them into micrococcos, mesococcos, and megacoccos, according to the relative size of the single globular elements; further, he applies the name streptococcos to globules of coccos when united in rows; petalococcos when united into a thin membrane on the surface of fluids; and gliacoccos to a mass of globules united into a small lump by means of an intermediate mucous substance. We cannot follow the description further here, and will only add that the same distinction is drawn between the different kinds of bacteria, meaning by bacteria those elements which have the form of a small staff. According to Billroth's observations, bacteria very often take their origin from coccos, and micrococcos from bacteria; and the two forms are even sometimes to be found together on the same plant. He therefore unites them into one group, and considers them simply as connected forms of vegetation of the same plant, which he calls the "Coccobacteria septica." In the botanical system he classifies them under the algae. He especially considers the so-called Dauersporen as the germs favouring the proliferation and propagation of bacteria, and has found that they resist much more powerfully the influence of the surrounding media

than do the vegetations of the plant themselves; and that such germs, after being kept dry for a long time, may set up a fresh vegetation if brought in contact with fluids. These Dauersporen originate by separation (Abschnürung) from the ends of the bacteria.

Contrary to the views of several botanists, Billroth does not assume any genetic relation between microbacteria and the fungi (Schimmelpilze), and he finds that oïdium (Hefe) never originates from microbacteria. These conclusions are the result of numerous experiments carefully arranged for the purpose.

Now, the different forms of vegetation of this single plant are to be found accompanying almost every instance of putrefaction of organic matter, as well as in the decomposition of animal secretions, and very often even the pathological secretions of the living human body. Although the greatest care was taken to find out a morphological difference in the form of vegetation under the above-mentioned different conditions, the same forms continually recurred; and so we have no reason to doubt the perfect unity of the vegetations for all processes of putrefaction. As we have said, they have nothing in common with the various organisms found in the different processes of fermentation.

Billroth found bacteria and micrococcos in the pericardial serum of eighty-seven out of 200 fresh human bodies. Prevalent were the larger forms of bacteria. In the blood of fresh bodies, organisms were not so frequent, yet often to be found. The diseases of which the patients died had no influence on the occurrence of bacteria in the pericardial

serum.

Billroth believes that they may originate from germs which existed during life, and developed into bacteria postmortem. Foul infusions of different tissues, putrid secretions, the infusions of fresh meat, and the serum of milk developed bacteria sooner and of larger forms than all other fluids, especially than blood and pus. In those fluids they were always found later, and in smaller quantities. Still more important are the results obtained from the examination of the secretions and tissues of living men. On the granulating surfaces of wounds and in necrotic tissues, coccobacteria were not frequent, nor in the fresh secretion of wounds before suppuration had come on. More were found in the fetid and decomposed pus of wounds, but not in every case where they were looked for; and, on the other hand, they were also found in cases where the pus was perfectly sweet without any trace of decomposition. Besides, it is a very important fact that microbacteria were found in several abscesses which never had, nor could have had, any communication with the air. In the blood of living men Billroth never could detect any organisms. He has found that they do not easily develope, either in fresh secretions or in fluids where putrefaction is finished, but that they are frequent during a certain period only of putrefaction. He comes to the conclusion that those organisms in the living body and its secretions are not in the least different from those to be found during the putrefaction of dead tissues. We have, therefore, seen, according to Billroth's experiments, that microbacteria can live only in certain fluids, that the vegetations die when they become dry, but that the enduring germs (Dauersporen) are spread everywhere in the air, that they can assume life again when brought under favourable conditions, and that they must be contained in various tissues of the living human body, although probably not in the blood.

If vegetations of coccobacteria originating in putrid fluids or other substances are transferred to other fluids of the same or of a similar nature, but in a fresh state and without decomposition, it does not always happen that they vegetate farther and cause putrefaction of the second medium. Very often they die without any apparent cause. Sometimes, it is true, they were found to have a rapid vegetation in the second medium, and in all those cases the decomposition of the fluid was also very rapid. Dry putrid substances gave the same results. Thus, for example, urine was very quickly decomposed by dried pus, but not by a dried infusion of meat. On the other hand, it has been proved by others that decomposition of organic matter is not always accompanied by living organisms, and may occur quite independently. Therefore we cannot presume that the living organisms are the true cause of putrefaction, but only a powerful adjuvant.

The reason why microbacteria, whose germs undoubtedly exist in the living body, do not vegetate under ordinary circumstances, is that (1) germs adhering to the external surface do not find the quantity of water which is necessary for their development, and that (2) the changes of nutrition

(Stoffwechsel) in the living tissues are too powerful to give way to those of the organisms, and do not afford them any appropriate food under normal conditions. Experiments showed that bacteria in putrid fluids did not vegetate further when injected into the blood of living animals, though the animals died from the influence of the putrid substances; and it is therefore still doubtful whether bacteria cause septic disease and putrefaction of the blood. Now, since it is the case that pus-which by itself is no appropriate substance for bacteria according to the experiments above mentioned-nevertheless contains those organisms rather frequently, Billroth is inclined to think that a substance is carried from the inflamed tissues into the pus which may afford a pabulum for bacteria. It very frequently happens that pus containing bacteria becomes decomposed but not truly putrid. It assumes a state of fermentation with the formation of butyric acid. When the inflammation around a wound ends in the formation of granulation-tissue, the decomposition of the pus and the vegetation of bacteria also cease. Such pus in a state of decomposition, and filled with organisms, is undoubtedly contagious; but it is not certain whether the air containing germs has such a highly infectious influence as is generally believed. Air may often remain for a very long time in cavities containing pus under very favourable conditions for decomposition-and yet the change may not occur. It is probable that the germs already lying in the tissues are brought into the pus when the tissues become inflamed, and then the vegetation begins. There is no other possible explanation, for instance, of the existence of bacteria in perfectly shut cavities. Accordingly, when we see decomposition of pus and vegetation of bacteria occurring in a healthy wound preserved from infection from without, those processes may be the result of special inflammatory changes. On the other hand, when sweet pus is brought in contact with decomposed pus we see a decomposition of the first and vegetation of bacteria. Billroth denies any influence of organisms on the acute progressive phlegmons so often occurring in fresh wounds; for he never could find the slightest trace of organisms in the inflamed tissues in those cases. He finds the cause of the progressive course of such phlegmons rather in the formation of a chemical substance in the inflamed tissues, which produces the same inflammatory change in the neighbourhood, which takes its origin everywhere in continuo where it is carried in sufficient concentration, and which produces again inflammation. This hypothetical substance is called by Billroth "Phlogistiozymoid." It is probable that not the cells, but the sap of the tissues contains it; and Billroth thinks that it is diluted by the pathological exudations, afterwards reabsorbed. and excreted, and that in this way the inflammation may be terminated. All the fluids containing this phlogistiozymoid Billroth considers as a good medium for the development of coccobacteria; and therefore such fluids containing bacteria are infectious. But quite the same processes may go on without any organisms at all. We cannot repeat here in extenso how Billroth endeavours to show that the processes of diphtheria, erysipelas, phlebitis, and thrombosis are also not due to the existence of organisms. In regard to pyæmia and septicemia, Billroth comes to similar con-clusions. He believes that in putrid secretions a substance may be formed which can be carried into the stream of the blood, and which can produce the so-called sepsis. This substance, a septic zymoid, he thinks is intimately related to phlogistiozymoid, perhaps even identical with it; and he is strongly inclined to consider the chemical processes of the inflamed tissues as analogous with those in putrid ones. not quite certain whether dry putrid substances produce true infection in the living body; but it seems perfectly certain that coccobacteria can carry and augment the zymoid substances, and that they may become contagious in that way. Coccobacteria is not essential to the presence of those substances, for many fluids containing those organisms do not produce any infection.

It is

In the last part of the work, Billroth examines the influence of a great number of substances-as sugar, alcohol, salts, and acids, and especially the so-called antiseptics-on the vegetation of coccobacteria. We must leave the results to the readers of the book. He then endeavours to examine, according to his own theoretical views on infection, the different methods of antiseptic treatment of wounds. The general conclusion at which he arrives is this: antiphlogistic treatment and antiseptic treatment are very intimately connected, inflammation and sepsis being two processes so nearly analogous. Then he

thinks that amongst other methods the open treatment of wounds is especially able to prevent a certain amount of the danger of infection, but that this prevention is not absolute, because the causes of infection very often do not occur from wi hout, but from the local processes in the wound themselves. Al hough Billroth believes the immediate danger and contagiousness of bacteria to be rather less great than others do, he also strongly recommends absolute cleanliness, energetic ventilation, and frequent general disinfection of the rooms and of all objects which the patients come in contact with.

We have given what must be considered a very incomplete report only of the chief results of this work, leaving the study of the questions themselves to the readers of the book. We have in it not a text-book for practitioners, but a large amount of working material for scientific men. While, on the one hand, we are grateful and full of admiration for the industry which has carried out such a large number of exact researches, we shall not go further, on the other, than to consider this new doctrine of inflammation and infection as a well-framed hypothesis, the absolute value of which is still uncertain, while its use consists in the fact of its opening up a great many views for fresh investigations. If we might have wished to see the researches on some one point or another even more fully carried out, we ought to consider that it would be the task of more than a lifetime-not to settle these questions completely, but merely in part. We cannot but heartily participate in the wish of the author that his work may call for criticism and discussion, for he thinks it better not to leave an empty space instead of a decaying house, but rather to raise a new building of his own.

Harvey and his Times: the Harveian Oration for 1874. By CHARLES WEST, M.D., Fellow of the Royal College of Physicians. London. 1874. Pp. 64.

In this Oration, which is gracefully dedicated to Sir George Burrows, Dr. West gives us a sketch of the personal appearance, character, companions, life, and works of the great Harvey, with a glimpse at the education and politics of the day, so far as they affected him, and with a passing notice of some of those convulsions of opinion which are the sure forerunners of changes in affairs of State. The whole is marked by great and becoming dignity of expression, and by a scholarship both wide and deep, and by an undercurrent of profound religious thought, which looks to a higher and better order of things hereafter, to solve and perfect what in things present is doubtful, ill-understood, and imperfect. He puts before us" the little dark-complexioned man with keen black eyes and curling hair; rapid in utterance, hasty in manner, choleric in his younger days, and used then in discourse with anyone to play unconsciously with the handle of a small dagger which he wore." Yet full of sympathy and love for his fellow-men; caring much for home and home friendships, instituting a quarterly meeting and dinner of the Royal College of Physicians for the promotion of mutual good feeling; exquisitely courteous in his tone of controversy with the rivals who attacked his discovery of the circulation of the blood; nor yet betrayed into bitterness by the mention of the ruffian soldiery of the Parliament, who had driven him from his home and his pursuits, had slain his Sovereign and his friend, and destroyed papers that recorded the fruit of years of labour. The loyalty and love of king and country which he suffered for in after life were probably kindled by the sight, from the cliffs of Folkestone, of the engagement in which the few ships which represented the English navy attacked the Spanish Armada.

Our space forbids us from lingering on the interesting topics of this Oration, which, as with other productions of the kind, can only suggest inquiry, without fully gratifying it. But there is one point so true, so practical, and yet so humiliating, and therefore so much ignored by some enthusiasts amongst us, that we must quote Dr. West's remarks. What was the good, it is asked, of the discovery of the circulation of the blood? Setting aside the undoubted truth that every discovery adds to the wealth-intellectual at least-of the race, "Still to us, as practitioners of the healing art, what help came there in the exercise of our calling? Was human life prolonged, was human suffering mitigated, as its direct and immediate consequence? To both these questions we must answer No; but the no must be accompanied by two qualifications.

"First.-In the ordinary affairs of human life many things are done rightly, but on wrong, or at least on insufficient grounds. The Ptolemaic theory of the Solar System

was wrong, but it served to calculate eclipses by, as well as the Copernican.

"But second.-We, with our narrow span of life, are naturally in a hurry for results. What comes not in our own time seems delayed indefinitely. In the world of intellect the remote consequences of discovery are long in disclosing themselves-impossible to be foreseen." No one could have foreseen the electric telegraph in Franklin's experiments made 120 years ago. But, thanks to Harvey's discovery, we can now ascertain the nature and seat of disease in each of the four cavities of the heart, foretell its course, and render death easy if inevitable. Moreover, though facts be ascertained, inferences may be wrong and need modification, as in the case of the cell-doctrine, which Dr. West, in his translation of Müller, greatly helped to make known thirty years ago. Or, a fact may be seen singly, and not in connexion with a system of which it forms part. Dr. West gives a wholesome check to those enthusiasts who desire to apply every crude physiological discovery or speculation at once to medical practice.

PHILADELPHIA, June 8. ANNUAL MEETING OF THE AMERICAN MEDICAL ASSOCIATION AT DETROIT.-REPORT OF THE JUDICIAL COUNCIL ON PROFESSIONAL CONTRACTS AND ON SPECIALITIES " BIDDING" FOR PROFESSIONAL APPOINTMENTS TO PUBLIC INSTITUTIONS-REFORMS IN THE REPRESENTATION-THE ARMY AND NAVY MEDICAL SERVICES-LIBRARY OF THE SURGEON-GENERAL'S OFFICE-TRIBUTE TO THE MEMORY OF DR. EPHRAIM MCDOWELL-MEDICAL MEN AT THE COMING CENTENARYA NOMENCLATURE OF DISEASES-PROPOSED INTERNATIONAL COMMISSION OF THE ASSOCIATION.

Ir has frequently happened in this country that physicians have been employed by corporations, etc., under special contracts, with annual salaries; and as this mode of securing their services has seemed to be somewhat derogatory to the dignity of the profession, the question was reported on by the Judicial Council. To this were also added the views of the Council on the subject of specialities in medicine, the code of ethics being the standard on which such views were based. It was contended in their report that the code very properly makes no mention of specialities or specialists, but presents plainly the rules necessary for the maintenance of professional character as applicable to all. As all special practice is simply a self-imposed limitation of the duties implied in the general title of doctor, it should be indicated, not by special or qualifying titles, such as oculist, gynecologist, etc., nor by any positive setting forth of special qualifications, but by a simple, honest notice appended to the ordinary card of the general practitioner, saying,. "Practice limited to diseases of the eye and ear," or "to diseases peculiar to women," or "to midwifery exclusively," as the case may be. Such a simple notice of limitation, if truthfully made, would involve no other principle than the notice of the general practitioner that he limits his attention to professional business within certain hours of the day; neither could it be regarded as a claim to special or superior qualifications. To give the specialist any privilege beyond this would be to invest him with a special privilege inconsistent with the equality of rights and duties pertaining to the whole profession.

In regard to the bestowal of professional services under specific contracts setting forth the amount of pecuniary compensation, the report states that the code of ethics prescribes that some general rules should be adopted by the faculty in every town or district, relative to pecuniary acknowledgments from their patients; and it should be deemed a point of honour to adhere to these rules with as much uniformity as varying circumstances will admit. This principle is inconsistent with contracts or agreements to attend individuals, families, companies, corporations, or any associations or institutions other than those of a strictly charitable character, for a specified sum per month or year, without regard to the amount of medical services that might be required in the time specified. It seems equally inconsistent with the ethical rule to enter into a contract with a manufacturing company to attend their employés, or with a school to attend its patrons or

scholars, for a fixed sum per annum, to be derived from the levy of a certain percentage on the wages of the employés or on the tuition fees of the students; for compensation for medical services should be in accordance with the kind and amount of services rendered, and every individual and family should be free to choose their own medical attendant without dictation or indirect restraint. These observations, the report goes on to say, do not apply to a certain kind of contract service sometimes required in connexion with the medical staffs of the army and navy, nor to the hospital tax sailors in the marine hospital system, for reasons too obvious to mention.

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There is a class of public charitable institutions, such as county almshouses, orphan asylums, etc., supported by public taxation. In many of the States the public authorities having control of such institutions annually ask for bids from the profession, offering to award the contract for professional services to the one who should bid for the lowest pecuniary consideration. The idea of asking members of the profession to bid against each other for the pay for public professional services is repugnant to every feeling of professional honour, and often productive of great injustice to the sick poor. The public authorities should fix such compensation for medical services as they may deem best, and then appoint the best medical man willing to accept the compensation.

The American Medical Association has hitherto received as delegates the representatives of every medical society, hospital, and medical college throughout the country which chose to send them to this annual gathering. Some of the bodies represented have possessed but little professional status; their position in the column of medical science has been at times obscure, and, perhaps, occasionally unworthy. Almost any organisation could be admitted to representation provided it endorsed the code of national medical honour prescribed by the Association, and the latter body, it was very evident, had become, from the nature of its own inherent composition, a mass of very heterogeneous materials. It was found that an endless variety of institutions were represented, some of them absolutely irresponsible. A thorough change has now been effected through the recent action of the Association, and hereafter a stricter basis of representation being adopted, the delegates will be chosen only from organised state, territorial, district, and county societies, and local societies which are recognised in their respective State organisations.

The medical staff of the United States army has never been on an equality of rank with the sister service of the navy, and efforts have been made to secure the legislative aid of Congress in its behalf. General interest has been awakened, and a direct appeal made to Congress, but the time selected was, as stated in a committee report on the subject, an unfortunate one for urging the claims of the medical staff. In consequence of the financial panic of last fall, the utmost economy in all administrative matters has been attempted, and at the time the Committee presented its memorial to Congress a very considerable reduction in the army had been proposed, and was under consideration.

The library of the Surgeon-General's office, at this time the largest collection of medical works, both foreign and indigenous, in this country, was brought directly to the attention of the Association by the presentation to the library of the latter of the catalogue of works embraced in it. As stated by Dr. J. S. Billings, its indefatigable librarian, a large number of foreign medical theses and pamphlets have recently been added to the library, making the total number of its titles about 65,000; but large as this may appear, it is not more than one-third of what our national medical collection should contain in order to place the medical writers and teachers of this country upon an equality with those of Europe in regard to facilities for consulting the literature of their profession. Probably, if a general raid were made by physicians on the musty contents of garrets, shelves, and closets, deficiencies in the files of journals, transactions, etc., might be readily supplied.

The following preamble and resolution, a tribute to the devisor of the operation of ovariotomy, were adopted :"Whereas a most laudable effort has recently originated in the Boyle County Medical Society of the State of Kentucky, and in the Kentucky State Medical Society, to create a fund for the erection of a statue, or some other suitable memorial, in honour of Dr. Ephraim McDowell, the father of ovariotomy,' English writers to the contrary notwithstanding, who lived in the town of Danville, in the State of Kentucky,

and who performed in that town the first ovariotomy in the year 1809-Resolved, That the American Medical Association most earnestly endorse the action of said county and State Societies, and as urgently commend the object to the generous consideration of the medical profession of the world."

Active measures have been already instituted in Philadelphia by the profession to incorporate with the centennial celebration of 1876 a welcome to the medical men of the world who may be present at that time, and especially to bring them together, by such medical organisation as may appropriately meet that end, in common interests. The American Medical Association has just taken the proper preliminary action to attain this object, and will perfect, at its next annual meeting, a plan to accomplish it.

Nothing further has been done tending to the adoption of a system of nomenclature such as that recommended by the Royal College of Physicians. The Committee asked to be continued; and for another year at least the system of nomenclature, slightly modified from the English one, which was reported upon a year or two ago, must remain unacted upon.

The report of the interchange of friendly greetings between our National Association and kindred bodies abroad is a pleasant feature to be mentioned. It was suggested by Dr. Seguin, one of the American medical representatives to Europe last year, that the American Medical Association appoint an international commission of physicians of high standing, speaking the European languages and designing to go to Europe this summer. They should be charged to represent the American Medical Association before the British Medical Association, the German and French Associations for the Advancement of Science, and other kindred societies, to promote interchange of ideas, and particularly to co-operate with them in any plan, scheme, or organisation which would have for its direct object the uniform establishment and propagation of the methods and instruments of positive observation; such Commission to report on the progress of this work at the next meeting of this Association.

These are the main points of general interest worthy of mention in the proceedings of the Association, and they have been carefully separated from purely local details, which would not interest our Transatlantic brethren. I purpose to give you in my next letter a sketch of the important addresses and papers presented to the Association proper, and of the discussions elicited on the reports, cases, etc., offered each afternoon in the various sections on Practice of Medicine, Materia Medica, and Physiology, Obstetrics and Diseases of Women and Children, Surgery and Anatomy, Medical Jurisprudence, Chemistry, Psychology, and State Medicine and Public Hygiene.

REPORTS OF SOCIETIES.

CLINICAL SOCIETY.

FRIDAY, MAY 22.

PRESCOTT HEWETT, F.R.C.S., F.R.S., President, in the Chair.

DR. BURNEY YEO exhibited a patient, a railway clerk, aged forty-five, who had suffered from winter cough for fifteen years, and for eighteen months from rheumatic pains in the limbs. He had had no other illness, nor venereal disease, save a slight gonorrhoea twenty years ago. Three weeks before the meeting he had slipped in coming downstairs, had slidden over a flight of stone steps, whilst holding on all the while to the iron railing, and finally had fallen on his back at the bottom of the flight. Soon after (he did not remember if it were the same night), he heard a "singing noise" in his chest on lying down in bed, which kept him awake. This continued to trouble him, and finally he came to the Brompton Hospital, complaining of slight cough and this noise in his chest. On examination, the chest gave evidence of cardiac hypertrophy. The apex beats an inch and a half outside and two inches below the nipple-line. There were evidences also of emphysema-viz., weak respirations generally, patches of dilated capillaries at costal margins, and exaggerated pulmonary resonance. The heart's impulse was increased, and there was a marked thrill at the apex. A loud vibrating musical sound was heard preceding the impulse at the apex, which became louder towards the base, and was loudest over the second right costal cartilage. The sound at the base appeared diastolic,