" OVER-PRESSURE IN SCHOOLS."

977 of these papers is to describe certain phenomena which are occasionally to be observed during the progress of disease of the nervous centres ; and he divides into two groups the

joint affections

which

respectively occur during the progress

of locomotor ataxy, and in hemiplegia dependent of one oi the cerebral hemispheres. "1

on

disease

ENGLISH DEGREES FOR ENGLISH STUDENTS. To the Editor of THE LANCET.

SIR,—Not only practitioners and students, but all patriotic Englishmen, must agree with the remarks in your leading article of November 1st on the continuous exodus of English

examination in, and grants a diploma for, medicine, which The moment a university medical a licence to practice degree is dissociated from an Arts degree, and allowed to become a licence to practise, it ceases as such to be anything more, and the whole of its value as a higher title will depend on the character and standard of the particular curriculum and examinations of which it is the end and aim. It cannot surely be difficult for a committee of both Colleges to prepare a scheme of complete union which shall be satisfactory to the English profession. The mere conjunction of the Colleges for examination purposes will not retain students at the London Schools nor make the London qualification more attractive; and if the fees remain exactly as in the separated Colleges, tkere can be no conceivable advantage 10 the English student in a mere corjoint board at all. Although the question of expense enters very little into this question of the driving away of students from the London schools, yet so large fees being charged for primary examinations must rather deter than attract students, and one sees no reason why either College should now charge ten guineas for exactly the same examination that each before charged five guineas for; it would have been fn better to continue to charge five guineas for each primary examination and twenty-five guineas for the double pass examination; but a little more liberality in this matter of fees would disarm much opposition to the scheme, and would probably result rather in a, gain than a loss in a pecuniary sense. The present is a great opportunity. On the boldness or hesitation of those who irlfluence the affairs of our two Royal Colleges depends the continuance of the success of our English Schools of Medicine-depends probably the future existence of the Colleges themselves. I am, Sir, yours obediently, WILLIAM HICKMAN. DoMet-square, N.W., Nov. 10th, 1884. an

is

medical students from their native schools. This is a matter with which pecuniary considerations have absolutely nothing to do, as at the present day the necessary expenses of medical education vary little on either side of the Tweed, and the fee for the double degree of M.D., M.S., in the North is about the same as that for the usual double qualification in London. I brought this subject forward at the meeting of the Royal College of Surgeons in March last, and then drew attention to the rapid decadence of the English schools of medicine. There is no doubt whatever as to the cause of this. The real explanation, as I then pointed out, is the fact to which you allude, that "no more learning is needed and no greater effort demanded to obtain a diploma of doctor of medicine in other places than is required in London and most of the English schools to obtain a mere licence to practise." This is, indeed, an under-statement of the facts, for in all that concerns medical knowledge and experience much more is demanded of a candidate for the English licence than of a candidate for a Scotch degree, as may be seen by anyone who will compare the regulations of the examining bodies. " OVER-PRESSURE IN SCHOOLS." A glance at the Medical Directory will show that about To the Editor of THE LANCET. 2000 practitioners suffice for the medical requirements of the whole of Scotland, whilst there are more than twice that 8IR,-In THE LANCET of .Nov. 15th there is a leader on number in active practice in London alone, and six times the above subject. Your remarks are well timed a.nd the number in addition in the English provinces. But at essentially to the point, and I believe that there are few the medical schools in Scotland there are probably twice as members of our profession who will be found to disagree many students as at all the medical schools in London ; a with their tenour. The subject is one of vital general considerable proportion moreover of those entering at the London schools find out afterwards the mistake they have importance to the future well-being of the nation, and it is in the settlement of which the medical made, and go off after one, two, or three years to other a subject, moreover, schools where their labours will be more fitly rewarded. profession is peculiarly concerned, for it is impossible, in my The result is that the English licentiate is everywhere thrust opinion, for anyone who has made the nature of disease a aside by the Scotch graduate, and elbowed out of office, study and its treatment a practice, to remain in ignorance of the fact that the present system of education is being employment, and profit; every honorary medical appoint- maintained at a ruinous, and to the general public, almost to him universal rule is closed the ment by admitting only inexplicable expense. The expense is not a monetary one, graduates, and he is necessarily relegated to a secondary but consists in the wasted energies and premature deaths of rank, and is thus and thus only prevented from rising to who, in other and more reasonable circum&tanceSy as such a professional position he might otherwise attain, and to which his qualifications and abilities would give him might have lived long and useful lives. To the members There is an easy and natural remedy of our profession whose daily work brings constantly under an indisputable right. for this state of things without calling upon the London or observation the relations which the various parts of the human frame bear to one another during life the difficulties any of the other universities to lower its standard, and without adding to the excessive number of licensing bodies already which at present roughen the educational road are easily otherwise with the general, and, as as. existing. At the meeting to which I have referred I proposed apparent; but it is The average that the two Royal Colleges of Physicians and Surgeons should rule, unthinking mass of the population. be amalgamated into one great Royal College of Medicine, parent desires that his children shall be educated as speedily,

children,

to be endowed with the power of granting the degrees of M.D. and M.S.2(see the report in your issue of March 29th). There is no need to call the United College a University, nor would there be any advantage in doing so. There is nothing either novel or incongruous in a college granting degrees; various instances might be cited from both ancient and modern times, but it will suffice to mention the University of Edinburgh, which was only spoken of as a college for more than a century after its foundation, and which, as Sir Alexander Grant says, "never did and never could become a university in the mediaeval sense of the term." Oxford, and Trinity College, Dublin, are now the only universities requiring the B.A. to be taken previously to the M.D., so that as far as medicine is concerned the College of Physicians is practically on exactly the same footing as any of the other universities-it prescribes a curriculum, conducts 1 THE LANCET, Jan. 28th, 1871, p. 117. 2 To the title "Royal College of Medicine," the words "and of

Physicians and Surgeons of England" could be added as a secondary title if thought desirable, to satisfy the scruples of some who might regret to part with these time-honoured designations.

cheaply, and as thoroughly as possible ; and he naturally regards with favour a system of education which endeavours to make up for lack of time by an increased amount of material, and it is with feelings of pride that such a parent will tell admiring friends that his boy of ten is almost fit tor as

leave school, and has his head stored with a wonderful amount of learning. The boy often begins to fag and to fall into a state of ill-health which is misunderstood by both parent and schoolmaster, and the educational mill is allowed to grind into dust all the fair promises of early boyhood, axd upon the very threshold of life this prodigy of youthful learning falls. His brain, over-driven and exhausted, is like a jaded horse, dull and irresponsive at a time when its best efforts are required, and his body, neglected and forgotten, fails with sad and ominous frequency in the performance of its duties ; and, in a word, a wasted life is the result, the inevitable result, of a premature and excessive demand upon the higher functions of the human frame. This is, perhaps, a somewhat gloomy picture, but if we consider for a moment the delicate and easily disturbed organism over which the

relentless educational

Juggernaut is driven, the

reason

for

978 from the room, and care is demanded that the boots shall be as clean as possible. 2. The Room.-This is thoroughly washed all over with carbolic soap as shortly before the operation as may be practicable, and the spray is often used for ome time before the operation. 3. The Apparatus.-The instruments are most carefully scrubbed with 1 to 20 of carbolic solution, the handles receiving great attention, and they lie soaking for a con. siderable time beforehand, if feasible. The protective, if employed, is also soaked before use. The outsides of all bottles, syphon-tubes, syringes, &c., are washed with one or other antiseptic; and tourniquets, Esmarch’s bandages, and o forth, all come in for attention. The usual porcelain trays are used to hold the apparatus, and are liberally supplied with carbolic or sublimate solution. 4. Tlze Patient.-The patient is cleansed as far as possible before being brought into the room ; and, if a limb is to be operated on, it is wrapped in a solution for some hours pre. viously. When laid on the table the patient may be enveloped in a blanket ; but if so, that is scrupulously covered by water. proof sheeting, the outside of which is sponged over with some solution. The exposed limb or part is now scrubbed with sublimate solution, then shaven and again washed. Now, all who have had to handle these unclean surfaces repeat the scrubbing of their own hands, and the operation

the gloom will perhaps become apparent. The labours of Ferrier and other workers in the field of the higher neural physiology have made it plain to us that the brain is to be regarded as the organ of mind, and that in the present state of our knowledge it is useless to consider even the most exalted thought, feeling, or imagination as phases of mental action which are apart from or above or independent of the change and interchange of material atoms. If we look upon the brain, then, as analogous to any other part of the human frame—as a muscle, for example-we shall easily conceive of its being over-excited and overwrought, and as a consequence exhausted, and even in process of time altered in its structural elements. A muscle, we know, becomes hypertrophied by over-use, and, if timely rest be not obtained, will also atrophy and decay. But how much more delicate is the brain than any other organ of the animal economy ? It is so delicate that nature, always provident and far-seeing, has provided for its protection a covering which combines lightness and strength in a degree The minute and varinever attained by any work of man. ously shaped cells, the fine network of nervous tissue, the subtle fluids, and the fragile and easily inflamed investing membranes, all have a part to play in the formation of every phase of mental action, and all become more perfect or inapt in the performance of their parts as the years pass by. Education, if one were permitted to describe so important a subject in a phrase, is essentially a physical process. The brain and body ought to be regarded as one to be educated together, and to grow in usefulness together. There is but one distinction worthy of present notice : the former is more easily deranged in its action and altered in its structure than the latter. Spencer, in his essay upon Education, remarks that the ancients educated the body and forgot the mind, while we in our day educate the mind and forget the body, and advises a combination of the ancient and modern conceptions of education. The evils of over-pressure are at present only apparent to the few, and even by the few their extent cannot be estimated. It is to the future that we must look for the direst result of the present syatem of education. I am, Sir. your obedient servant, ROBERT MACPHERSON. Glasgow, Nov.

18th, 1884.

commences.

5. The

Operation.-No instrument,

or

appliance of

any

sort, is allowed to touch the patient unless both it and the

hands of the assistant are absolutely beyond suspicion. Thus, if the assistant rests his hand on the table, the operator will not take an instrument from that hand until it has been washed, not dipped. In fact, the guidivg principle is that nothing shall touch the open wound which, either primarily or secondarily, has been in contact with an unclean surface. The dressings vary with the fancy of the operator. Iodoform glycerine, 1 to 20, figures largely, as also iodoform gauze, It is customary to cut away the outside foot or so of any carbolised bandage, and the outer surface of a fresh mass of salicylic wool is never allowed to be placed next the skin,

-,

REGINA VERSUS C. F. J. B. BRIGGS AND ELIZABETH BRIGGS.

ANTISEPTIC SURGERY. To the Editor of THE LANCET. To the Editor of THE LANCET. SiR,—I beg to call your attention to this case, wherein it SIR,-I enclose a sketch of rules observed, in their main appears that a very serious miscarriage of justice has taken features at least, by many German and Austrian surgeons ; place.

and I cannot help thinking they will be quite novel to most At the last Nottingham Assizes a man named Briggs and in this country. Statistics are not of much use, or I could his mother were tried for the murder, by starvation, of quote some remarkable series of abdominal operations with- Thirza Briggs, the wife of the male prisoner. I enclose you out deaths in which these rules were rigorously observed. a newspaper report of the trial and notes of the evidence. In private practice much of this elaborate care is imprac- It was proved that the mother-in-law of the deceased ticable, but I venture to believe that one single rule is behaved with great cruelty to her, and that the husband (a almost alone requisite. It is this : Let the air be as free weakly and nearly blind man) did not supply his wife with from dust as possible, and allow nothing to be brought in food. It was proved, however, that the deceased had silver

wound, or parts near, which is itself impure, or has touched any doubtfully pure surface. How far this can be carried out without special training is another I am, Sir, yours faithfully, matter. A. OGIER WARD, M.B. and C.M.Edin. Tottenham, Nov. 17th, 1884. RULES OF ANTISEPTIC SURGERY IN GERMANY AND AUSTRIA. 1. The Operator and Assistants.-During the previous twenty-four hours they should not have made any postmortem or anatomical dissections or vaginal examinations, nor have attended any infectious cases ; but if any of these risks have been run, extra cleansing of the person is demanded. On the day of operation care is taken that no scurf shall fall from the head, and the beard is carefully attended to. At the time of operation the coat is removed (also collar and waistcoat in some cliniques), and a clean apron or short-sleeved linen jacket is put on, the arms being bare to the elbows. Hands and arms are washed, first in hot water, then in a corrosive sublimate solution, 1 to 2000, or else in 1 to 20 carbolic solution, and the nail-brush is diligently employed for the entire hands and arms, not for the nails alone. A basin of this solution is in frequent use throughout the operation, and if anyone touches any unpurified object, he must again wash his bands and not merely dip them. In some cases the coats and hats are excluded contact with the

...

____

T’YT’._-

in her possession, and that she procured food from her neighbours during the six weeks immediately preceding her fatal illness ; also that she had as recently as July been staying some weeks with friends, where, it was admitted, she had everything she required. On Sept. 28th she fell down in a fit, and on Oct. 3rd she died comatose. A post. mortem examination was made and an inquest held, when a verdict of wilful murder was returned against the two prisoners. At the trial two medical men, who had made the post-mortem, swore that the deceased died of serous effusion on the brain, the result of starvation. On that evidence the male prisoner was found guilty of manslaughter and sentenced to twenty years’ penal servitude. Now, Sir, I venture to state that the post-mortem examination entirely failed to prove starvation, and that the sworn facts of the case were absolutely incompatible with starvation. I am, Sir, yours obediently, The Sanctuary, Nov. 25th, 1884. THOS, BOND, F.R.C.S.

THE REMOTE EFFECTS OF GOUT. To the Editor of THE LANCET,

SiR,-I read with much interest the description of the relation of certain diseases of the eye to gout, as reported last week in THE LANCET. Mr. Hutchinson has remarked bis lecture on the obscure non-arthritic effects which gout

in