A CENTENAL YEAR.

31 civil but candid reflection upon his judgment. This article struck that note of criticism without fear of persons which the original WAKLEY intended should be characteristic of his venture, and which involved him in a group of libel actions for some ten years, in most of which he won actual or moral The offer to supply a complete chronicle of LONDON: SATURDAY, JANUARY 6, 1923. current literature " was met by quoting from the London Magazine a letter by " EuA" to ROBERT SOUTHEY, whom the Editor of THE LANCET described A CENTENNIAL YEAR. as a " sack-hunting hypocritical rhymer," thus expressDURING 1923 THE LANCET will complete 100 years ing the opinion of the Radical party upon the Poet The first number appeared on Laureate, who had renounced the Republican and of its existence. Sunday, the 5th of October, 1823, and contained a Unitarian views of his youth, to appear as a defender prefatory statement to the effect that the objects of of the Established Church. A short paragraph, the new journal would be, primarily, " to produce a which promised mysterious revelations concerning a work that would convey to the public and to distant clergyman, led to the editorial request for certain practitioners, as well as to students in medicine and information concerning that person, with which the surgery, reports of the metropolitan hospital lectures "; number closes. Having regard to the direction which and, secondly, " to give a correct description of all those revelations afterwards took, we cannot be the important cases that may occur whether in England surprised that in the second number the Editor of And as THE LANCET has changed his printer. or on any part of the civilised continent." How far THE LANCET, as it now appears, differs though this programme was not sufficiently inclusive, THOMAS WAKLEY, the Founder, with the audacity of from the journal in its first decade might be made youth-he was 28 years of age-added to his inten- the subject of self-congratulation in obvious directions, "Our columns will not be none of which we propose to take; and, while we may, tions the following: restricted to medical intelligence, but, on the contrary, or may not, regret, we cannot apologise for the absence we shall be indefatigable in our exertions to render from our pages to-day of the gay scurrility which THE LANCET a complete chronicle of current litera- enabled WAXLEY to command from the beginning a ture." Those with access to the first number of large audience for his projects of reform in the medical THE LANCET in its original form may note with profession. We are more than content to believe that interest or amusement how far in the space of 36 small in essential design-namely, the desire to promote the octavo pages it was attempted to keep the promises cause of medicine and the interests of its practitioners made. -we have remained the same paper throughout the The metropolitan hospital lecture selected for hundred years. We publish in another column a report was one delivered on the lst of October, 1823, letter from Sir JOHN TWEEDY, whose personal recolby Sir ASTLEY COOPER, and it is a good example of lections of THE LANCET go back to the day of its chatty exhortation to a medical school, the students Jubilee; and a retrospect over our first fifty years, present being described by the Editor (it may be suggested by this letter, shows the manner in which feared with an eye on possible subscribers) in these the original policy expanded, the varying places in words:--"We never before witnessed so genteel a which it was justified, and the singleness of the surgical class ; the sight was most pleasing, for they essential design. The whole pattern of hospital all appeared gentlemen of cultured manners and good training was altered during those fifty years in accordarticle ance with plans suggested or supported by writers I Politics," whose medical interest is exactly nil, but in the editorial and correspondence columns of the editorial opinion of the younger PiTT as " an THE LANCET, or endorsed by those writers, often in official coxcomb, regardless of everything but the a forcible fashion. Nepotism at the principal hospitals gratification of his own senseless, remorseless, and withered under this treatment, and the strictures petty ambition," indicates from what political were not confined to the leaders of the profession, for sections of the public, whom he proposed to address persistent exposure of the imperfect training which equally with medical men, the Editor hoped to obtain many medical men received was a powertu-L assistance support. PITT, of course, had been dead some years, to the passage of the 1858 Act of Registration. While but his name was used as a point of rally against the intention to appeal to the public directly was Radicalism. Some notes on the drama were followed abandoned quite early, the purpose of this intention by three carefully written clinical cases from Newcastle- -namely, to effect sanitary and social reforms-was on-Tyne, from Lynn in Norfolk, and from Bedford, carried out by close inquiry into manifest abuses. indicating the design to excite the interest of widely From the beginning the claims of quack medicines separated centres. Then came a long quotation, were subjected to the chemical analysis of the day, under the heading Medical and Surgical Intelligence, and, when these methods were directed to the detection from the columns of the London Medical Repository. of food adulteration, a movement was started which In this excerpt Mr. HENRY EARLE, assistant surgeon led to the important legislation which we now possess. to St. Bartholomew’s Hospital, carries on a con- The part played by THE LANCET fifty years ago in troversy with Sir ASTLEY COOPER, as to whether the reform of workhouse infirmaries, and in the fracture of the neck of the thigh-bone ever unites, institution of Hospital Sunday, shows again the and also as to whether COOPER had said that EARLE determination to prove the connexion between the was maintaining the contrary view in order to deprepublic weal and the work of medicine. But we do not ciate Guy’s Hospital and its teaching-for COOPER, wish either to enumerate old exploits or recent while lecturer at St. Thomas’s Hospital, was surgeon developments and activities. It is more fitting that to Guy’s Hospital. From the journalistic point of view we should acknowledge a genuine feeling that nothing there was considerable sagacity in publishing in the in those early days could have been done by this first number of the new medical paper, and in the paper, as nothing can be done by us now, without front pages, an address by the acknowledged leader the cooperation, intimate help, and valuable of surgery, while reprinting, as a quotation, a very criticism of our public. One little blow of our own

THE

LANCET.

verdicts.

education." A leading "

succeeded entitled

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32 we permit ourselves-we do not believe that readers would have supported us through an unbroken century they had not found us serviceable.

trumpet

our

if

SYMPTOMATIC TREATMENT. A

medical I impulse

literature than he receives at present. The towards a more scientific conception of medicine has led to the dismissal of too many disorders in text-books with the curt advice to " treat the cause." But as " A Pathologist " acutely points out in our correspondence columns there is a kind of disease prevention-and a very important one at that-which has nothing to do with ultimate causes and which can be pursued with success in ignorance of them. Exact illustrations of this situation may be found in Dr. Fortescue Fox’s address on the Breakdowns of Middle Life which is printed on p. 55. To-day it may be assumed as common knowledge that we must treat the cause when we see it, but if it is not manifest even after careful search, or if when found it is irremediable, much may still remain to be done the medical practitioner. A series of articles, contributed by invitation, will appear weekly in our columns, and will represent individual experience in the treatment of diverse medical and surgical conditions arising commonly or rarely in practice. Every practitioner is occasionally perplexed by patients who do not respond to the treatment he is accustomed to order, having found it successful in apparently analogous cases. Aural or

I

medical student not long ago achieved the succinct tone of the following answer to an examination question : Etiology—unknown ; prognosis-doubtful; treatment-nil. He had indeed summed up with depressing accuracy many pages in many text-books recording unsuccessful attempts to elucidate the prime cause, the probable duration, and the proved cure of the rather uncommon condition named, and he deserved credit for a just résum8, which could have been an expression of nothing but industry, for without wide reading he would not have dared to assume that his answers But in medical practice a less uncomwere adequate. attitude is necessary, while the problems promising presented by patients are not always of the concrete sort that can be so briefly dismissed. Assuming that this examinee had been asked to differentiate between possible causes of this condition, to mention points in history that might influence prognosis, and to vaginal discharge, subacute rheumatism, intestinal recommend treatment in certain associated symptoms, worms, neuralgia, sciatica, habitual constipationhe would have had much to say if he was really a all these are among the conditions which he may well-informed person, and, especially under the third find intractable in patients of every class in life, and heading, he would have been placed somewhat in the ’, it is no reproach to him that he is not familiar with position of the practitioner while arranging his all the methods that have been adopted successreplies. The practitioner may be unable to suspend fully for their relief, or certain which of these methods operations until the most direct line of attack has has the most direct applicability in a given case. been ascertained ; he may have to advance somehow, Personal experience which would have stood him in if only by engaging hostile forces as and when these good stead in five or six of the conditions we have manifest themselves, and even when their immediate enumerated may fail him in a seventh ; his hospital origins become clear the causa causans mav remain training yields only generalities, while he knows that obscure. a new technique now holds the field ; his text-books There is thus a difference in outlook and in respon- may be silent ; and search through medical literature sibility between the research student and the practi- is laborious. To meet these circumstances, which tioner, and undoubtedly this leads to difficulties in our letter-bag shows to exist, we have asked the help the professional training given at the medical schools. of writers who enjoy peculiar opportunities for Some persons even contend that at the present day helping their colleagues. the training given bears but little relation to the daily work of the practitioner. A cogent answer to such criticism is that if the student in his early years NEUROSYPHILIS AND ITS PREVENTION. is encouraged to think in terms of symptomatic THE solution of the problems presented by neurotreatment his ideals will never rise above this level. It is the duty of the teaching staff of a hospital to syphilis and its treatment, attacked though they have equip a practitioner with a just conception of the been from every side during the last decade, has not processes of disease as at present understood, and with yet been attained. We have no specific technique for treatment at all comparable in certainty of result to a comprehensive, if somewhat dogmatic, knowledge of various antitoxin methods for some of the other and examinathe standardised accepted therapeutics ; tions of the universities and corporations should test infections, nor, for that matter, are we absolutely sure the candidate on these points. He will then be found of our organism, as far as neurosyphilis is concerned. competent at diagnosing common ailments, medical In his instructive address on modern methods of and surgical, including some of the most important diagnosis and treatment of syphilis of the nervous diseases and injuries, and he will be able from hospital system, which will be found elsewhere in this issue of training to estimate their urgency, and decide on their THE LANCET, Sir FREDERICK MOTT argues for the treatment. He may not, however, have close acquaint- existence of two varieties of spirochsete implicated in ance with some of the things which are judged by the syphilis, the dermatropic and the neurotropic respecpublic as too trivial for hospital advice, and, alas, these tively. Notwithstanding the authoritative position of will include the early manifestations of many impor- this eminent neuropathologist, which must lead us to tant illnesses, and he will have had little opportunity weigh seriously his contentions, the actuality of these for learning the reasons why he should vary thera- two distinct varieties is as much denied as accepted, peutic measures in many conditions which appear and the evidence is still conflicting. The discovery similar, or why he should adopt a particular course of different strains of meningococcus has turned out in a particular case. Only individual personal to be of prime therapeutic significance in respect experience can make this side of his professional life of the successful treatment of cerebro-spinal fever; easier, but where an individual patient is suffering by comparison, the indefiniteness of our knowledge of from some serious disorder for which no specific the Spirochcsta pallida is a hindrance in the way of remedy presents itself, it seems possible that he progress. Even though the assumption is made of might get more help from his teachers and fromI one variety only, we are greatly in the dark as to its SENIOR

praise by

by