ROYAL LONDON OPHTHALMIC HOSPITAL.

THE MEDICAL PROFESSION IN PRUSSIA. army is worth investigating, as, like everything pertaining to the army in Prussia, it has been the object of great solicitude on the part of the government. There are at Berlin two preparatory establishments allotted to the pupils who intend to devote themselves to the medical department of the army. They are the Institute of Frederic William, which bears the name of its founder, and the Military Academy. The young men

who wish to enter these establishments address their petition to the physician-general of the central staff. On their admission they agree to serve two years in the army for each year of instruction which they receive. The pupils of the Institute are about one hundred and forty in number. They are fed and lodged at the expense of the state, follow gratuitously the lectures of the Medical Faculty, and receive, moreover, a small sum of money for their private expenses. The pupils of the Military

Academy

pay for their board and

lodging,

but attend the

lectures without expense. As a compensation they only bind themselves to remain in the military service half the time exacted from their comrades of the Institute. The duration of their studies in both schools is four

the title of

457

staff-doctor (Stabs-arzte).

In the

hospital

immediately after and surgery, who are appointed rank

the doctors in medicine to the hospital. The station-doctors are their subordinates. Like them they are lodged and boarded in the hospital. It is from among their body that are taken the regiment doctors

hierarchy they

(regimen ts-artze).

regiment doctors have only to pass of division doctor (generalgrade-that through the to attain arzte), highest point of military hierarchy, of the viz., grade physician to the general staff (generalstabs-al’zte). From this slight sketch of the medical military career it will be seen that the facilities for acquiring a practical knowledge of disease enjoyed by the military students are infinitely greater than those enjoyed by the non-military students. The higher medical officers of the army being deservedly much respected and honoured, and well paid, admission to the two military schools is eagerly sought after. There is still, however, another one

The

other

class to which

we

must allude-the

surgeons’

assistants

The regiment and battalion doctors allowed to choose in each company, with the consent

(chirurgen-gehuelfen). are

they instruct gratuiperform the part of a dresser culum, and acquired the title of doctor, the pupils of the tously, so Institute enter the hospital of La Charité under the name in the garrison hospital. These soldiers must, at least, of station-doctors (stations-doctoren). There they fulfil be able to read, write, and cypher. They are boarded the duties of house-surgeons or house-physicians, and and lodged in the hospital. At first they merely prepare perfect their practical knowledge of disease. Of the baths and apply blisters and moxas. At a later period, after pupils of the Military Academy only a certain proportion learning a little anatomy, they assist the surgeons to enter the Charite. The 44 station-doctors" remain in apply bandages, and the apothecary to prepare the methe Charity for one year. Each has under his care from dicines. For the first two years they are only apprentices. forty to sixty patients, whom he is obliged to visit four They then become surgeons’-assistants, and have the times a day, twice with the medical functionary of the rank of corporal. After nine years’ service they assume ward, and twice alone. He is obliged to keep a correct the rank and receive the pay of sub-officer. After twelve account of the history of each patient, and the most years service they acquire, in common with all subalterns curious cases are consigned in a monthly report. The of that standing, the right to some civil appointment. station-doctors are not allowed to publish their cases in Prussia being an essentially military country, is anxious any medical journal ; the books in which they are con- to provide well for the subalterns of its army, as by doing tained are deposited in the archives of the hospital, and so a double advantage is secured. The sub-officers remain the head physicians and surgeons alone can make use of longer in the service with a view to the civil appointthem. The station-doctors are lodged and boarded, and ments ; and the administrative posts which are given to receive a salary of about 141. a year. When they leave them serve as a substitute for pensions. The surgeons’-assistants, when they have left the army, the Charité they enter the military service as surgeons. The former pupils of the Institute are obliged to serve continue to make use of the practical knowledge which eight years, and those of the Academy four, but the they have acquired in the garrison hospitals. Following length of service is generally abridged by one-half. They , the example of the first and second-class surgeons, they are distributed in the various garrisons, and receive practise medicine as well as surgery, and thus increase about 181. a year as pay. Their rank is that of serjeant- the rivalities and collisions which are sure always to exist wherever different grades of practitioners come in major. years.

After

they have terminated their university curri-

of the

commander,

a

soldier whom

as to enable him to

contact.

After the period fixed for military service has expired, the military surgeon has three paths from which to choose : he can remain in the army, in which case he becomes immediately a "battalion doctor" (bataillons-arzte), but cannot progress further; or he returns to the Institute of Frederic William, to serve as teacher for five or

thelris,

six years, or he quits entirely the military service. The teachers of the Institute return at the end of the period mentioned to the hospital of the Charity, with

unhealthy-looking individual, oscasionaUy subject to general rheumatism, became an out-patient under Mr. Scott, Sept. 26, for the relief of rheumatic inflammation, commencing in

HOSPITAL REPORTS. ROYAL LONDON CASE

OPHTHALMIC HOSPITAL.

1.-RHEUMATIC OPHTALMITIS.-Bulging forward of

and consequent dimmution of the size of the Anterior Chamber.-William Whittalcer, aged sixty, a stout but

458 the internal tunics of the right eye. The palpebral integument was puffy and elevated to a slight extent ; the vessels of the conjunctiva were partially distended with blood, particularly at the inner two-thirds, and several large tortuous vessels were also prominent. At the inner and lower third of the circumference of the cornea, the straight, deep-seated, radiating vessels were remarked. The pupil more dilated than the left, and comparatively inactive ; iris dull, and very convex, bulging forwards into the anterior chamber, the capacity of which it much diminished. There existed dimness of vision and haziness over objects. He complained of severe pain in the forehead, not, however, referred to the eye-ball, lasting from four o’clock in the afternoon to eleven I at night. Tongue furred ; face flushed. He was pre- I scribed for as follows :-Ordered: Cupping from the right temple, to twelve ounces ; a blister to the nape of the neck ; powder of scammony and calomel, ten grains, to be taken immediately. Wine of colchicum, half a drachm ; carbonate of magnesia, ten grains ; water, an ounce, Mix for ’, a draught, to be taken three times daily. : October 3. The pain was slightly relieved ; mercurial ointment, with opium, was ordered to be applied to the forehead. 6. Pain in the forehead of much less intensity and dura-

I

tion, commencing about

ten at

night.

’

10. An attack of acute conjunctivitis supervened, mani-

fested by a sensation of sand in the eye ; reticular injection of the vessels, and a puriform collection at the inner com- If missure. The affection of the conjunctiva subsided in about a fortnight, at the end of which period he complained only ’, of occasional darting pain at night-time, referred only to the globe ; the pupil had all but resumed its natural action, and ’ the iris appeared of its normal colour, but oscillated slightly during its movements. The anterior chamber was of the All symptoms of acute rheumatic insame size as the left. flammation had now subsided, the result having been dim-’, ness of vision, and occasional local pain, which symptoms still continued. The use of the colchicum was persevered in till November 17, when a scruple of bark and soda was ordered to be taken three times a day. The pupil at this time was slightly irregular. November 27. The iris was observed to be decidedly tremulous, and in the course of a month its anterior surface bad become slightly concave, thus increasing the size of the anterior chamber, a condition exactly the reverse to that existing at the commencement of the attack. Dimness of vision still continued ; he could, however, read a good-sized print with tolerable facility. CASE 2.-Jane Stubbington, aged fifty-five, a married woman, became an out-patient in the spring of last year, complaining of excruciating pain in the left eye, the sight of which, however, had been lost twelve months prior to her present application. The organ presented the following appearances :-Globe denser than the right ; seven or eight large tortuous vessels ramifying in the ocular conjunctiva; lower part of the cornea also having on its surface several similar vessels continuous with the above ; iris perfectly dull and inactive; pupil much dilated and occupied by a dense glaucomatous cataract. She complained of violent, excruciating pain in the globe, as though some one were hooking the eye out of the socket, which felt, as it were, too small for it. She experienced, also, a sensation of large gravelstones between the eyelids and the globe ; pain in the forehead and temple of a violent rheumatic character, intermittent, the periods of its occurrence continuing for about sixteen or twenty-four hours. The disease, according to her account, commenced by impairment of vision, a mist appearing. This was soon followed by sparks and muscle, which gradually increased in number. In proportion to the advance of these symptoms, pain increased, and the power of vision gradually diminished, till it ultimately became destroyed. Right eye has never been affected. She has been subject to severe attacks of rheumatism for eight or ten years, which attacks commenced three or four years after the cessation of the menstrual discharge. From the period of her application to the beginning ot January, she took a considerable quantity of medicine, which chiefly consisted of iodide of potassium and quinine at intervals. She was These remedies, also frequently cupped and blistered. however, proving tfficacious in a very slight degree only, she was ordered to take wine of colchicum, half a dmclun ;

magnesia, ten grains ; three times a day. In of three weeks all the pain had subsided, and she experienced a degree of ease and comfort which she had not had for many months. She was now ordered to take bark and soda occasionally. In a couple of months she discontinued her visits. CASE 3.-Itosetta Joel, a nurse, widow, aged fifty, applied for relief, April 16. The left eye exhibited the following symptoms:-Conjunctiva not inflamed, but suffused with tears on the exposure of the eye for a short time to a strong light ; pupil dilated, transverse diameter being much larger than the vertical ; anterior chamber diminished in size ; iris very convex, broader at the lower than at the upp’’r part, of a dirty brown colour, particularly at its superior and external portion ; no visible action ; the humours, posterior to the pupil, of a greenish opalescent aspect; globe itself more prominent than the right, and to all appearances larger. She says that sparks of fire, as though they came from a candle, are constantly rolling about in every direction, she has no black spots before the eye ; the power of vision so much impaired, that when any is held before her there exists no power of definition, and she is only sensible of the presence of something the nature of which she cannot determine. Painful sensation of weight, referred to the outer part of the globe, and a pricking and shooting sensation to the eye generally, frequently extending to the temple. She is affected with similar pain in the temple and eye of the right side. The right iris, however, acts freely, and there exists no dulness either of it or of the humours, and she complains only of occasional flashes, which have been of about a month’s duration. The left eye has beenaffected about seven months, the affection commencing with flashes, sparks, and obscurity of vision, a sensation of heaviness and pricking. She is subject to pain in the head, particu. larly at the top, and it is of a rheumatic nature. The menstrual discharge ceased about nine years ago. Tongue clean, pulse small, 85. Ordered to take colchicum mixture (ut supra) three times a day. In the course of a month, under the use of this medicine, the pain had materially abated, and the iris had lost much of its duskiness, and acted slightly. Vision also had become somewhat improved. May 20. She continues the medicine, and is progressing carbonate of the

course

object

favourably. The primary seat of this affection in the tunics of the globe is evidenced by the dilated condition of the pupil, owing to the sensibiiity of the retina being impaired in the early stage of the disease, for had the iris been affected at its outset the pupil would necessarily have been contracted. The rapid increase in the volume of the vitreous humour (as related in case 1) which attended the inflammation, and to which alone the bulging forward of the iris can be attributed, is an unusual circumstance ; and still more so its diminution, and the consequent receding of the iris on the subsidence of the inflammation. It is also remarkable, that while colchicum is of no avail in the treatment of that form of rheumatic inflammation which commences in the iris, in that which talces its rise in the internal tunics of the globe it is of decided efficacy, and often when the disease has gone (as in case 2) to the extent of irrecoverably destroying the function of the retina, and has also rendered the lens and vitreous humour opake, it will subdue the inflammation, and effectually relieve the agonising pain that attends it.

ROYAL COLLEGE OF SURGEONS OF IRELAND. To the Editor

of THE LANCET.

SIR,-Lest it should be supposed that there exists among the members of the profession in Ireland any party to which the article header 11 Medical Politics," in the 11 Dublin Medical Press," of the 12th of June, can with any justice be considered applicable, it has appeared necessary that the following notice should be taken of it ; and I request that you will have the goodness to give it a place in your Journal, in the hope that it will tend to remove any impressions likely to be excited by that publication prejudicial to what it calls 11 the minority," whose succesaf ul opposition, nevertheless, on the late occasion of an election to a vacancy in the council of the College of Surgeons, seems to have caused the learned editors so much irritation. These