venience which would result if such a privilege were generally indulged. It appeared to him strange that the College of Surgeons should criticise the report on State Medicine, which was in an unfinished state, and which they could never have seen. Dr. ANDREW WOOD replied that they had taken the information from the proposal of Dr. Acland.

Dr. ALEXANDER WOOD had no desire in the remarks he made to cast any slur on the College of Surgeons of Edinburgh; it was simply with a view of protecting this Council from what he believed to be the beginning of a most inconvenient practice. Dr. CHRISTISON, while feeling bound to vote for the motion if it were pressed to a division, would be glad to see it withdrawn if Sir D. Corrigan and Dr. Andrew Wood could see their way to so doing.

Dr. STORRAR Would encourage every form of petition and communication between the licensing bodies and the Council; but at the same time the Council must always exercise its own judgment in regard to placing such communications on the minutes or not. He did not think that this communication was one which ought to be placed on the minutes.

Sir DOMINIC CORRIGAN replied, and pointed out that many other communications of much less importance had been already admitted on the minutes during the present session. He therefore could not consent to withdraw his motion.

The PRESIDENT, in putting the motion to the vote, stated that he had no intention of voting upon it, but he felt bound to express great regret that the suggestion of Dr. Christison had not been acted upon, and the motion withdrawn, for he certainly did feel that extreme inconvenience would necessarily arise by the introduction of a document of this kind, which certainly was an invitation to corporate bodies each year to send in communications containing reviews or criticisms of the proceedings of the Council.

The motion was negatived by a majority of one, the numbers and names being as follows:

Declined to vote, 2-Mr. Cooper and Dr. Paget.

A letter from Dr. Maclagan, of Berwick-upon-Tweed, respecting lunacy certificates having been read,

Dr. ANDREW WOOD moved that a communication be addressed to the Home Secretary upon the subject, calling upon Government to redress the grievance. He pointed out the great inconvenience which existed in the present state of the law, an instance of which had lately come under his notice, where a gentleman travelling in England having been taken mad at Preston Railway Station, his friends were actually obliged to send to Scotland for a Medical Practitioner before they could get a certificate which would enable them to remove him to a Scotch asylum.

Dr. MACROBIN seconded the motion.

Dr. BENNETT suggested it would be desirable to communicate with the Lunacy Commissioners before taking any step in the matter, and after some remarks from Dr. Fleming the motion was put to the vote and carried unanimously.

A memorial from Practitioners in Lanarkshire respecting misconduct on the part of a registered person was about to be read, when the Council requested the reporters to withdraw, it being doubtful whether the matter contained in the memorial were libellous or not.

Dr. PARKES then moved-"That the Registrar be requested to write to the Secretary of the Queen's University in Ireland, asking for the report of the committee of the Queen's University, to which the report of the committee of the Medical Council on the visitations of examinations was referred." The question he wished answered was whether the Queen's University had complied with the recommendation of the Council respecting preliminary education. He found that every other licensing body had complied with the request of the Council except the Queen's University, from whom the answer had come that the matter had been referred to a committee, which committee, however, had not yet reported on the subject. The object of the motion was to obtain the report of the committee, and he would propose, by leave of the Council, to add the

following sentence:-"That if this committee have not reported, the Registrar be requested to write and require a definite reply to the passage in the report of the Committee on the Visitation of Examinations which referred to the preliminary examinations of the Queen's University."

Dr. EMBLETON seconded the motion, and said that what he wanted was a distinct answer in writing as to what the Queen's University intended to do.

Dr. STORRAR quite concurred in the general spirit which had actuated the mover and seconder of this motion, but he thought the time had gone by when it was desirable to put it in force, because, although no direct reply had been obtained from the Queen's University to the question put to them some two years ago, the Council was nevertheless acquainted with the fact from Dr. Lect's visitation of the examinations, and in other ways, that the Queen's University still persisted in allowing students to commence their Medical studies before they had passed the arts examination, which the Council declared ought to be preliminary. Without indulging in any rhetorical display, he would call the attention of the Council to a simple statement of the facts upon this question. Some years ago-almost indeed from the commencement of this Council-it was decided that it was important students should pass an arts examination preliminary to the commencement of Medical study. It took some time to bring the examinations of all the bodies in conformity with this recommendation; but in England and in Scotland it might now be said that all the bodies in Schedule (A) had conformed to it. The only difficulty was in bringing the standard of examination up to the point desired; but there was no dispute either in the English or Scotch colleges as to the preliminary examinations. In Ireland it was otherwise; and, particularly, the Queen's University had distinctly declared that that was not the practice there, and that they did not approve of the course suggested by the Council. This matter ought to be settled one way or the other. Either the Council was wrong or it was right, and without any severe remarks of a personal kind, or directed towards any particular college, the time had now arrived when it ought to be made clear whether the communications of the General Council were to be attended to or not. He had, therefore, a motion to propose, which was an amendment upon Dr. Parkes's-"That this Council having issued recommendations to the bodies enumerated in Schedule A of the Medical Act-viz., that no Medical student shall be registered until he has passed a preliminary examination, as required by the General Medical Council,' and 'that no licence be obtained at an earlier period than after the expiration of forty-eight months subsequent to the registration of the candidate as a Medical student '-and this Council having learnt that the regulations and practice of the Queen's University of Ireland are not in accordance with these recommendations, the Council request the attention of the Queen's University to this want of accordance, and express the hope that, before the next annual meeting of the Council, the University may be able to announce to them that their regulations and practice are in conformity with the aforesaid recommendations, and thereby avoid the necessity of a representation being made by the Council on this subject to her Majesty's most Honourable Privy Council, under the 20th section of the Medical Act."

Dr. BENNETT felt the importance both of the motion and of the amendment, because this question of preliminary education lay at the root of all progress. All the licensing bodies, with the exception of the Queen's University, had carried the recommendations of the Council into effect sooner or later, and at all events had acknowledged the good sense of the regulations and the desirability of enforcing them-manifesting in that way their readiness to assist the Council in carrying out its functions. In the case of the Queen's University it appeared they had not only done so but distinctly expressed an opinion which was not in unison with that of the Council. Without considering the question whether the Queen's University had or had not good grounds for holding that opinion, it was quite clear on their own confession they declined to act in accordance with the regulations of the Council; and the Council was placed in this position-that a regulation which it considered to be the very foundation of all progress in Medical education was distinctly repudiated by one of the licensing bodies. Under these circumstances the Council would be guilty of the greatest dereliction of duty if it failed to obtain obedience to its regulations, and to avail itself of the power conferred by Act of Parliament of asking the interference of her Majesty's Privy Council. He trusted that Sir D. Corrigan and the Irish members would see the extreme desirableness of preventing the necessity for any such application, but he (Dr. Bennett) did not hesitate to declare that

he should be quite prepared to support any motion for referring this matter to the Privy Council if it was found that all efforts were vain to enforce obedience to the Council's regulations. He believed they would have the support of the Profession at large in such a step, and certainly they would have the support of Sir John Gray, after the oration which he made in the House of Commons. (Laughter and applause.)

Sir D. CORRIGAN Would not have risen but for the threat that the proceedings of the Queen's University would be brought before the Privy Council. Speaking as the representative of the Queen's University, he accepted the challenge, and, as far as his influence went, he would refuse to accede to the recommendation of the Council on extra-professional education, because he believed the Council was wrong, and that the Senate of the Queen's University was right, upon that subject. It must be remembered that the question was not one of whether a preliminary examination should or should not be gone through; the question was which system of preliminary education was the best, and he warned the Council to look well before they dared to bring the Queen's University before the Privy Council. In limine they would be met with this objection, that no man could be summoned to undergo a penalty for not following a recommendation. The authorities might recommend travellers to proceed by one of two roads, but there could be no penalty for choosing one rather than another. The Council had not yet issued a regulation upon the subjectwhy not? Because they were afraid. So that upon the very threshold of the Privy Council they would be turned out upon that law point. The only question upon which the Queen's University could be taken before the Privy Council was one upon which he (Sir Dominic Corrigan) was quite ready to meet the Council-namely, whether the plan laid down for educating a body of persons for the Medical Profession by the Council was better than the plan followed by the Queen's University. That was the question; and the very first document he would produce on the table of the Privy Council would be the returns from the Army and Navy Boards, which showed that, from the commencement of those returns up to the present time, not a single graduate of the Queen's University, as far as he knew, had been rejected. [A voice: That is not so.] Perhaps he was wrong in saying not a single one; but at any rate the numbers rejected of graduates of that university were far less than those from other quarters. There was a test upon which he would meet them before the Privy Council as to whose system was the best. It was not fair to say that the Irish bodies neglected extraprofessional examinations. It was true they did not require their students to go through such a wretched preliminary examination as that which was visited by Dr. Storrar. And what was his report upon it? "Very often bad--some so bad that it is not easy to see why they were allowed to pass." And then they talked about taking the Queen's University before the Privy Council to disfranchise it because it did not follow their wretched plan, for he could not call it anything else. He would like to see them there. What did the Queen's University do last year when a man was examined and passed his Professional examination in Medicine and Surgery and all Professional subjects, but was reported at the Senate to have been deficient in his extra-professional papers? Why, they sent him back for a year. Was that neglecting extraprofessional education? The Queen's University admitted no man to pass its examination who had not undergone the most strict examination in arts. They contended that their plan of education in arts was better than that recommended by the Council, which persisted in receiving crude little boys of 14 or 15 years of age who had passed a most imperfect preliminary examination, which was to test once and for all his proficiency in general education. The Council had passed the second lustrum of its existence; from the course they were pursuing they would never see a third, if he was at all able to read the signs of the times. The Council accepted the certificates of other bodies upon extraprofessional subjects, and he would call attention to the papers at the Cambridge local examinations for boys not exceeding fifteen years of age, which were received as a sufficient foundation for subsequent Professional study of the man, without any requirement of future examination in arts. question was which mode was the best of preliminary study, that recommended by the Council or that pursued by the Queen's University. He was quite prepared to meet them at the Privy Council, especially upon such examination papers as those issued by the Cambridge and Oxford local examiners, whose certificates the Council accepted. The learned baronet then proceeded to cite some amusing instances of sentences without verbs, and of questions involving "bulls" and other inaccuracies. For instance, the Oxford papers gave the

The

following sage advice:-"Candidates are recommended not to dwell too long upon any single question, so as, if possible, to answer all upon the paper;" and the Cambridge professors required to know "the male of heifer." He had been charged by Dr. Alexander Wood with thwarting the Council in refusing to bring a recalcitrant body before the Privy Council on a former occasion. Dr. Wood alluded to the case of the College of Surgeons of London, against which there was at that time the same personal feeling as now existed against the Queen's University. The resolution which was opposed by him was a gross libel upon a body which had produced a Cooper and a Brodie, and which was then singled out by them as a sort of bête noire, just as they now sought to make a bête noire of the Queen's University. The Medical Council had, by lowering the minimum of education, lowered the maximum of qualification for the Profession, until at the present moment the certificate of any educational establishment from Nova Scotia to the Cape of Good Hope that a preliminary examination had been passed by any boy before the age of fifteen, was considered a sufficient foundation for after Professional study. And then to talk of haling the Queen's University before the Privy Council! He accepted the challenge, and was quite prepared to stand or fall by any comparison which might be drawn between the one system and the other, especially if the army and navy returns were consulted. Dr. ALEXANDER WOOD, in reply to the remarks of the last speaker, said that, while always admiring the talents of Sir Dominic Corrigan, there was one gift which he did not admire, and which he was thankful not to possess, and that was the perverse ingenuity with which, on almost every occasion upon which he addressed the Council, he covered up the real question at issue, and raised other suggestions and illustrations for discussion which had nothing whatever to do with the subject on hand. The learned baronet had boasted his accuracy of reference, but he (Dr. Wood) remembered an occasion upon which a calendar was telegraphed for from Edinburgh, to settle a dispute upon a matter of fact with Dr. Syme; and Sir D. Corrigan, when he found he was wrong, refused to apologise. Again, during the present session he had read a document and omitted a portion of it which told in favour of his opponent, Dr. Thomson. As to the charge that the Queen's University had been singled out for persecution, the truth was that it was Sir D. Corrigan himself who had singled out the body whom he represented by stating that under no circumstances, as far as his influence could affect its decision, would the Queen's University accede to the recommendations of the Council upon this subject of preliminary examination, and he had just expressed himself prepared to go even before the Privy Council breathing the same defiance which he had breathed at the Council table to-day. He felt the time had now arrived when the Council should take some decisive action in the matter.

The hour of six having arrived, Dr. Embleton moved the adjournment of the debate, and the Council rose until Wednesday, 2 o'clock.

-

CARUNCULE MYRTIFORMES. M. Demarquay, commenting upon the case of a young woman sent to his Hospital from the country, in order to have some malignant tumours removed from the genital organs, observed that on examination everything was found in a normal condition with the exception of the carunculæ myrtiformes, which, being somewhat enlarged, were mistaken by the Practitioner for epithelioma. It is, he observed, by no means rare for him to have similar cases sent to him by Practitioners who are not accustomed to the constant examination of the organs like himself.-Union Méd., June 20. IODINE AND ACONITE IN PERIODONTITIS.-We quoted in our number for February 20 a statement by Professor Abbott, of New York, to the effect that of all the remedies for periodontitis he had found equal parts of officinal tincture of iodine and tincture of aconite root applied to the gums by far the most effectual. He applied it with a camel's-hair brush or a piece of wool at the end of the stick, in the early stages of the inflammation once a day, and in very severe cases twice. Unfortunately, he did not state the dose, but this omission he has supplied in a communication to the Dental Cosmos, in which he also states that he is more than ever satisfied with the remedy. In each application from two to three drops of the mixture are used-that is, one or one and a half drop of the aconite. He adds that "the fluids of the mouth should be kept from it until the alcohol is sufficiently evaporated to prevent its being washed from the part to which it is applied. This requires

about a minute."

OF MENTAL AS COMPARED WITH MECHANICAL ACTION OF THOUGHT AS A RESULT OF CHEMICAL ACTION-IS THE BRAIN TO BE LOOKED UPON AS A VOLTAIC BATTERY?-ON EXPRESSING THOUGHTS-OF THE NERVE MATTER CONCERNED IN MENTAL ACTION OF THE CHARACTER OF THE GERMINAL MATTER OF THE NATURE OF WILL, AND OF THE LIFE OF GERMINAL MATTER TAKING PART IN MENTAL OPERATIONS.

(Continued from Vol. I. 1869, page 622.)

Of Mental as compared with Mechanical Action.

IF a machine could be made which would change from time to time, of its own accord, the kind of work it performed without any alteration being made in its mechanical arrangements, a rough comparison might be drawn between such a machine and the brain, but a machine of the kind supposed exists not, and is not conceivable.

Do the actions of the mental apparatus exhibit any analogy to those performed by a vast number of highly complex machines so arranged as to be under the influence of one person, this or that being made to work according as he willed? In this case we must further suppose every machine to be constantly wound up ready to be brought into operation on the instant, and capable of being stopped with facility. Or can we imagine an immense telegraph system which, besides communicating information, shall be capable of effecting mechanical work? The supposed machines must have no breaks or any of those arrangements to prevent injury or over-action, as in the various kinds of apparatus made by us. And further, our machine ought to be made of soft material, like brainmatter, and every portion of it should be capable of gradual renovation. Such conditions, however, we know, cannot possibly be fulfilled, and therefore no true analogy exists between any machines made by us and the nervous mechanism concerned in mental action. But admitting that they might be, and without laying stress upon the fact that the nervous apparatus, unlike the machine, keeps itself in order and in working condition if only the rest needful for its repair and renovation be granted, we have still to discover the hand that guides the mental engine, its superintendent, who bids the wheels revolve or stops them, who allows the work to proceed or checks it, as he wills. What sort of a guide can we find in the case of the mental machine, where is he seated, and how does he influence the complex apparatus under his immediate care and sole control? In what spot in the brain are we to search for him? But is not the structure of the grey matter such as to preclude the possibility of the existence of anything exhibiting an analogy to any mechanical arrangements known? We understand its construction sufficiently to justify us in concluding that the nervous matter óperates in a manner different in principle from that of any known mechanism.

It has been said that in the brain we have "molecular machinery" built by the sun, but no one has shown what this supposed molecular machinery is like, what is its structure, how it acts, or how it is formed. Molecular machinery is a term which conveys no idea whatever to the mind. No one could draw or make a model of the supposed molecular machinery. We may have molecular matter, and we may have machinery, but there are no machines the molecules of which are active, and there are no molecules which act like machines-in fact, there is no molecular machinery, and it is scarcely necessary to say nothing whatever has been built by the sun. The expression is altogether incorrect, is calculated to mislead, and, there is reason to think, has led many to accept conclusions utterly at variance with established truths.

Of Thought as a Result of Chemical Action. Some have expressed the opinion that thought was to be

explained by the oxidation of chemical compounds in the brain. Judging from some of the remarks which have been made concerning the supposed chemical changes in nerve matter, one would infer that the brain, instead of consisting of millions of separate anatomical units exhibiting an elaborate structure and arranged in beautiful order, was but a mass of fatty albuminous pulpy material, rich in phosphorus, the action of which was determined by the oxidation of certain of its component elements, particularly the last, the oxygen being carried to the nerve pulp, and the products of chemical change being removed from it by the blood circulating in the vessels freely ramifying in the substance of the pulpy mass. But although there is no doubt that in the expression of thought chemical changes take place in the nerve matter, it has yet to be proved that thought itself results from chemical change. It would be more in accordance with what we know to conclude that thought preceded and determined the chemical change occurring in the brain matter, than that it was a consequence of it. Chemical change will not alone account for any vital acts whatever. If the movements of part of a mass of living matter in advance of other parts were due to chemical action, such movements would soon be produced in the laboratory, but chemistry has not yet advanced one step in this direction. The special action of any particular apparatus is not usually explained by asserting that it is due to the disintegration and oxidation of its constituent parts-of its wheels and cranks, for example-and yet some will have it that the action of the cerebral apparatus is to be satisfactorily accounted for by the disintegration and oxidation of the matter of which it is composed.

Is the Brain to be looked upon as a Voltaic Battery? "Another hypothesis, to the legitimacy of which no objection can lie, and one which is well calculated to light the path of scientific inquiry, is that suggested by several recent writers, that the brain is a voltaic pile, and that each of its pulsations is a discharge of electricity through the system. It has been remarked that the sensation felt by the hand from the beating of a brain bears a strong resemblance to a voltaic shock, and the hypothesis, if followed to its consequences, might afford a plausible explanation of many physiological facts, while there is nothing to discourage the hope that we may in time sufficiently understand the conditions of voltaic phenomena to render the truth of the hypothesis amenable to observation and experiment." (a) By adducing in its favour such a statement as that about the resemblance of the beating of a brain to a voltaic shock, Mr. Mill condemns his favoured hypothesis, for it is certain that if there be any resemblance between a brain and a voltaic pile it is not of the kind implied.

Has

Mr. Grove has recently (b) remarked that in "a voltaic battery and its effects" we have "the nearest approach man has made to experimental organism;" but surely it should be shown in what particulars a voltaic battery resembles an organism. All organisms come from pre-existing organisms, and all their tissues and organs are formed from or by a little clear transparent structureless moving matter which came from matter like itself, but may increase by appropriating to itself matter having none of its properties or powers. Now, voltaic batteries do not grow or multiply, nor do they evolve themselves out of structureless material, nor, if you give them ever so much pabulum in the shape of the constituents of which they are made, do they appropriate this. What, then, does Mr. Grove mean by asserting that a voltaic battery is the nearest approach man has made to experimental organism? man yet made any approach whatever to experimental organism? What does Mr. Grove mean by the term experimental organism? If any apparatus we could contrive developed all possible modes of force-motion, heat, light, electricity, magnetism, chemical action, and any number of others to be discovered that apparatus would still present no approach whatever to any organism known. Of course such a thing might be called an organism, just as a watch may be called a creature, or a worm a machine; but everything that lives, every so-called. living machine grows of itself, builds itself up and multiplies, while every non-living machine is made, does not grow, and does not produce machines like itself. Mr. Grove further says that in the human body we have chemical action, electricity, magnetism, heat, light, motion, and possibly other forces, "contributing in the most complex manner to sustain that result of combined action which we call life." Here it seems to be affirmed that forces sustain the result of their own combined action, but surely this is only asserting that these forces sustain (a) Mill's "Logic," p. 18.

(b) British Medical Journal, May 29, 1869, p. 486.

themselves. Heat, light, electricity, etc., sustain the result of the combined action of heat, light, electricity. It is, moreover, said that what we call life is the result of the combined action of motion, heat, light, electricity, etc., which are but different forms or modes of one force. But, as every one knows, we may have any and all modes of force without life. Life, therefore, it would seem, involves something besides force, or is something different from it.

But it may be that each little brain cell with its connected fibres in some way resembles a minute voltaic battery with its wires; the matter of which the cell is composed undergoing chemical change, in the course of which slight electrical currents are developed. These being transmitted by the fibres ramifying to different parts exert an influence upon tissues and organs among which they ramify. In this case some further arrangement is required by which the action of particular cells and fibres is determined or prevented. Perhaps the closest analogy we can draw between cerebral action and that of an electrical battery is the following:-We may suppose multitudes of delicate conducting wires or threads ramifying over extensive tracts of tissue, the action of which is determined by the currents traversing the wires. Situated among these wires or threads, we may suppose little bodies connected with one another which are capable of undergoing alterations in form. Not the slightest movement can occur in any part of these bodies without an effect being produced upon the currents traversing the delicate wires which impinge upon them. Points in a vast number of circuits differing widely in their ultimate distribution are thus brought, as it were, within the influence of these little bodies, and the rate of transmission of the current through many different wires having different destinations and acting upon diverse machinery may thus be affected at the same moment, determining a variety of actions. But if it be admitted that the brain in structure and action resembles such an arrangement of minute voltaic batteries and conducting wires, we have to explain how all these were formed and made to take up the positions they occupy in relation to one another and to other organs before we can give an account of its action. For the kind of work performed by a machine is due to its structure as well as to the forces by which it is set in motion. And further, the movements occurring in the little bodies supposed to act upon the currents transmitted by the threads must take place spontaneously, which in any artificial arrangement is of course impossible.

On Expressing Thoughts.

But in considering the nature of mental nervous action, it is necessary in the first instance to distinguish clearly between the mental action-the actual thought-and its expression. The conversion of thoughts into symbols which others can appreciate is due to a highly elaborate mechanism working in the most perfect manner, but it by no means follows that if we understood exactly the manner in which the mechanism works, we should therefore be able to form an accurate conception of the nature of thought itself. Thoughts and ideas may, and in some cases do, undoubtedly exist, although they cannot be expressed in any way in consequence of the destruction or derangement of the mechanism concerned in expression. And in certain forms of cerebral disease intellectual action is performed, although the mechanism concerned in expression is completely deranged. Ideas are formed by the mind, and although the person can indicate this and convince us by his gestures that he has the idea, he is quite unable to express it and make it intelligible to others. The mechanism concerned in expressing thoughts consists of a nervo-muscular apparatus arranged with such consummate skill, and occupying so small a space, that it is possible for the mind to form but a most imperfect conception of the arrangement of even a very small part of it.

It is difficult in many cases to decide to what extent the apparatus concerned in expressing ideas is engaged in silent reasoning and cogitation. When we think over complex matters, and reason upon them, we work with certain mental images or symbols of the things, but certainly not with the verbal expression of them, nor even with their representatives, but with something far short of either, though sufficiently distinct and exact nevertheless. A great number of these images may be marshalled, as it were, before the mind almost in a moment, and conclusions arrived at which would require the greatest cleverness and a long time accurately to express. And in but too many instances, after making the greatest efforts, we only succeed in conveying to the minds of others the roughest, coarsest representation of a mental image which to us is distinct, clear, and perfect in all its details. And it is

well known how much more fatiguing is the operation of expressing than that of thinking and drawing conclusions mentally. The results of a few hours' thinking, obtained without any perceptible exhaustion and without any conscious effort, may require many days' hard labour to reduce to a form intelligible to other minds, and in this operation even the health may suffer, as well as the mental vigour be impaired. It would therefore seem as if thinking and cogitation belonged to the class of actions I have distinguished as vital which are performed without waste or change in constitution of material substance, while the expression of thought undoubtedly involves material changes of the most active kind. We may roughly compare the first to the acts of an engineer who directs and controls a machine, and the last to the work of the machine itself. The engineer or superintendent, it may be said, merely exerts a directing and controlling influence which has nothing whatever to do with the combustion of coals or the falling of the weights, uncoiling of the spring, etc. He contributes nothing that can be weighed or measured towards the work performed by the machine. He can exist without the machine, and the latter may act without him, yet we all know how very much the result produced, as regards quantity and quality of work, is due to his interference.

(To be concluded.)

ORIGINAL COMMUNICATIONS.

NORWEGIAN NOTES.

By JONATHAN HUTCHINSON, F.R.C.S.,

Surgeon to the London Hospital, to the Ophthalmic Hospital, and the Hospital for Skin Diseases.

(Continued from Vol. I. 1869, page 683.)

I SAW at the Christiania General Hospital several other cases of much interest in reference to the treatment of syphilis. Among them were two infants suffering most severely from the congenital form.

Syphilitic Disease of Viscera in an Infant.

One of these, an infant, aged eight weeks, was very ill. Its liver was much enlarged, and probably the spleen also. Dr. Bidenkap told me that he had begun with syphilisation, but, the inoculations not taking, he had abandoned the plan, and was now contenting himself with giving iodide of potassium to the mother. The mother's history was interesting. She had never been syphilised, nor had she taken mercury or any other specific. Her primary disease was at the time believed to be local, and she had double suppurating buboes, but never any rash whatever. The fact that her infant has suffered with such unusual severity cannot be considered encouraging to the adoption of the merely expectant plan. It will probably die. Severe Congenital Syphilis after Cure of the Mother by Syphilisation. The other infant also presented severe symptoms, and I should think its recovery doubtful. Dr. Bidenkap was adopting the syphilisation plan of treatment, and was inoculating every second day. I inquired as to how its mother had been treated, and was informed that she had gone through a complete course of syphilisation by Professor Boeck two years ago; that after fourteen weeks' treatment, all symptoms having disappeared, she was discharged "cured," and had remained well ever since. She was a young unmarried woman, and looked now in good health.

At first sight this is a clear fact against the idea that syphilisation really eradicates the taint, for here we have a well"cured woman becoming the mother a year later of a wretchedly diseased child, just as we see so often after other methods. It is only fair to the plan, however, to suggest that the taint may have come from the father's side also. The Christiania Surgeons, however, and the Professor himself, I believe, amongst them, fully admit that syphilisation-cures do not prevent the cured from becoming the parents of tainted offspring. Dr. Bidenkap said to me, We have had a large number of mothers who, after such cures, have borne healthy children, but in many it has happened otherwise." Dr. Fayes, in a report from the Lying-in Hospital, has recorded eighteen cases in which syphilised women became mothers afterwards, and states that almost all their children died with more or less distinct syphilitic symptoms. Some have even asserted that "the offspring of syphilised women are invariably syphilitic." The most that Dr. Gjor, the very intelligent Surgeon to the Christiania Lock Hospital, and an advocate of syphilisation,

can assert for it, in this respect, is that its results are not worse than those of other methods. (a)

Cure by Syphilisation does not prevent Transmission to Offspring. We may, then, I think, take it for proven that syphilisation can make no boast as to preventing the occurrence of transmission to offspring-one of the main objects of all plans of treatment, and perhaps the very best test of the reality of a cure. Our Norwegian confrères have great advantages over us in inquiries of this kind. Their towns are small, and, the population being stationary, their patients cannot escape them. These advantages have been put to use with the most praiseworthy zeal and industry. Records are kept at each public institution, and if a woman should be delivered in the Maternity of a pocky child, her antecedents can, in all probability, be easily ascertained by reference to the archives of the General Hospital. So far as a stranger could appreciate, it also appeared to me that there is an amount of friendly co-operation in these matters from which we in England might well take example.

The Male Venereal Wards-Patients under Lock and Key. The feature which first called for notice in passing to venereal wards for men was that they were all as carefully locked as those of a lunatic asylum. Dr. Bidenkap told me that "otherwise the men would escape." have you power to keep them here against

"Then," I asked, their wills?"

"Certainly," he replied.

"Do you really mean," I urged, "that you can make any man who has syphilis come under treatment whether he wishes it or not."

"Certainly," he said, "we do not consult them about that. If I know that a man has syphilis, it is at my discretion to order him into the Hospital, and to make him stay there till he is well. If I think he may be trusted not to risk the spreading of the disease, I allow him to remain at large; otherwise I take him in."

"Then," I asked, "can you go to a man whom you suspect of having the disease and compel him to submit himself to your examination ?"

"I would not go to him. I would send a policeman, and make him come to me.'

Dr. Bidenkap, I must state, in addition to his Hospital appointment, holds the office of Medical Director of sanitary matters to the town, and is thus especially concerned in carrying out the laws against contagious diseases. I gathered from our conversation that it is not unusual to enforce them in the case of males amongst the poorer classes, and in females it is of course constantly done. Subsequently, during my visit to Bergen, Dr. Hjerdal confirmed the above statements as to the stringency of Norwegian law, but he thought that it was rarely enforced in the case of men. In the Bergen Sygehus, or General Hospital, the venereal wards contained much fewer patients than those of Christiania, and none of them were locked.

Syphilisation in the Male Wards.

Almost all the men whom I saw were under syphilisation treatment, and most of them were doing well. Dr. Bidenkap said that three months was an average stay in Hospital, and that they were never allowed to go until well. No treatment is ever adopted until bona fide secondary symptoms show themselves. Dr. Bidenkap appears to believe firmly, though not enthusias tically, in its comparative advantages over other methods. He does not consider it so efficient against tertiary as against secondary symptoms. I saw a man named Johan O., now aged 27, who had syphilis eight years ago, and tertiary ulcers in the throat two years ago, for which latter he was syphilised and got well. He is, however, now again under care for the same, though in a milder form. Sarsaparilla is now being tried.

I shall recur to the subject of the treatment of syphilis when I have seen the Bergen Hospitals and those at Christiania a second time. It will be seen that two very important experiments are being tried here, and tried, too, boldly, on a large scale, during a long series of years, and with special advantages→→→ the first the plan by syphilisation, and the second that by the entire disuse of mercury and other specifics. It is possible that syphilisation is, as many believe, only expectancy in reality. At any rate both are well worthy our attention.

(a) I have taken some of these facts from the printed report of a discussion at the Christiania Medical Society, at a meeting held in the beginning of the present year. It contains the opinions of many observers, and, as it took place after the report to our own Medico-Chirurgieal Society by Mr. Lane and Mr. Gascoyen, has additional value. The opinions are very various, and some of them strongly against syphilisation. Dr. Boeck has, with his characteristic love of truth and of full investigation, had the whole report translated into English.

I inquired of Dr. Bidenkap as to the relative prevalence of the several forms of cryptogamic skin disease. On most parts of the Continent these are, I believe, much more frequent than in England. He told me that Norway was no exception to this rule. Tinea versicolor he regards as so common that "almost every one who wears woollen has it," and it is not thought worth treating. Both ringworm and true favus (here skurv) are, I said, very frequent.

Alopecia areata is reported not common. Dr. Bidenkap does not believe that it is cryptogamic. There was no case of favus in the Hospital. Professor Boeck also reported favus as fairly common, and as I do not in London, in the practice of the Skin Hospital and the London Hospital both together, see more than one or two a year, I think we may feel certain that it is far more frequent in Norway.

Rarity of Molluscum Contagiosum.

The curious malady known as Molluscum sebaceum or contagiosum is, on the other hand, I believe, almost an English disease. It is very rare in Paris and in Berlin and Vienna, and no Continental atlas with which I am acquainted contains a portrait of it. Professor Boeck told me that he did not think he had ever seen it, and Dr. Bidenkap had seen only one or and had obtained no evidence as to its contagiousness.

two cases,

On the Frequency and Severity of Scabies.

I have not as yet seen any case of unusually severe scabies (Scabies Norvegica), and am told that they are very rare. Of scabies in its ordinary form there are plenty of examples. Oliver Goldsmith, when he travelled through Norway, observed that almost all the peasants had the itch, and I fear that the last century has but little mended matters. Neglect of ordinary cleanliness, difficulty in obtaining Medical advice, and the habit of shaking hands on all possible occasions, may perhaps combine to explain this prevalence. If you give a Norwegian peasant anything, and he wishes to express his gratitude, he will shake hands with you. Thus you have to shake hands with all the waiters, chambermaids, and carriole-boys with whom you have business, and may thus enjoy the opportunity of inspecting many hands in the course of a day. Even to the most cursory glance a large number of them show signs of the disease. At a little roadside inn (Hacg) I gave a small present to each of five children in succession, in order to have an opportunity of seeing their hands, and all of them had most unmistakable itch. In some districts, however, I see but little of it. All the Surgeons with whom I have conversed admit its extreme prevalence. It is almost a pity that the Government, which is parental in many matters, and is zealous in its efforts to improve the condition of the peasantry, does not take measures to put the means of cure of scabies within the easy and gratuitous reach of all.

The Prurigo of Hebra.

Hebra has restricted the old name "prurigo" to one single group of cases, of which he has given a very clear description. (b) Its special features are extreme itching without proven cause, the appearance of a lichen rash, usually placed in certain definite positions, and arranged symmetrically. It commences in childhood, and lasts, in spite of all treatment, through life, without tending to shorten it, unless, adds the Professor, its intolerable annoyance causes the sufferer to commit suicide. Its cause is unknown, but it is to be taken for granted that it is not an external one. I think it will be granted by English observers that cases fitting with this description are very rare. I have myself been carefully on the look-out for such, and have found very few indeed. Two recently under care, to which I was disposed for some time to give this name, were afterwards proved to be attended by body lice, and in all probability caused by them. Yet in Vienna Hebra speaks of the disease as frequent, and refers to an experience of thousands.

Dr. Bidenkap, who formerly studied under Hebra, showed me two patients in whose cases this diagnosis had been given. One was a girl of about 15, and the other a lad a year or two older. Both had suffered for years, and in both, from scratching, etc., the skin had become thickened, of a deep brown from pigment, and spotted over with small whitish but indistinct

scars.

In both patients I thought there was good reason to suspect scabies; indeed, in one it was known to have been present, and both were to me suspicious of pediculi. We talked over these conjectures, and Dr. Bidenkap alleged, with much force, that if any large proportion of the cases of Hebra's prurigo are really (b) See New Sydenham Society's translation of his work.