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SPECIAL HOSPITALS.
Mr. ROGERS HARRISON advocated the use of carefully-applied pressure to the varicose veins. Dr. ROGERS had seen the plan of Mr. Lee carried into effect in many cases in University College Hospital. Had Mr. Lee seen a strong solution of iodine applied to the varicose veins ? Dr. SlORDET had seen several cases successfully operated on by Mr. Erichsen on Mr. Lee’s plan. Mr. CANTON had treated a great number of cases with tincture of iodine most successfully. The iodine was applied to the surface, and appeared to act by absorbing the products of inflammation surrounding the vein, and reducing the vessel to its normal calibre. Mr. HIRD had seen, in cases treated by caustic successfully, other veins become after a time varicosed. There was generally some constitutional defect in persons suffering from varicose veins, and, in addition to local treatment, tonics-such as iron, were indicated. Mr. HUNThad seen the disease return frequently after the veins had been obliterated in various ways. This was, no doubt, from some constitutional cause. He recommended the use of the laced stocking in opposition to the elastic stocking; the application of the plaster of ammonium and mercury along the course of the vein, with lint and flannel bandages, were n of much service in some of these cases. Dr. RouTH referred many of these cases to accumulations in the prima vise, and recommended the use of purgatives-such as the bitartrate of potash in large quantities. The best mechanical means of support was a pair of tight.fitting drawers. Mr. Lee having replied, the Society adjourned.
Foreign Department. ANNUAL MEETING OF THE ACADEMY OF
MEDICINE, PARIS. much animation pervaded the
ON the 15th of December last, hall where the members of the Academy generally meet, being the day fixed for the annual award of prizes, and the delivery of the accustomed panegyric on a departed member of the
learned
society.
As to the rewards granted in France for medical investigations and essays on various subjects, we have only to repeat what we have stated at various periods before-viz., that such incitements to exertion in the several branches of medical science, are considerably more numerous in France than in our country ; a circumstance which explains the scientific activity of our neighbours, We cannot help remarking, however, that Great Britain has, in the al seace of diJ’ect encourzzrgemezat, contributed in an admirable manner to the elucidation of medical questions, and to the introduction of valuable adjuncts to actual
practice.
It will be interesting to inquire of what nature are the questions upon which the various committees, appointed by the Academy, did not feel justified in awarding the actual prize ; merely granting sums of money (equal in amount to that offered for the prize) as encouragements to authors. In this manner we can judge of the weak points amongst onr neighbonrs. The prizes not awarded were the following :1. Prize of .640, given by the Academy: " Settle, by clinical facts, the degree of utility of issues, in the treatment of chronic
diseases."" 2. Portal
prize of X40"Point out the organic changes produced by rheumatism, and indicate the characters by which they can be distinguished from the changes occasioned by other
causes." (No essay was sent in.) 3. Lefevre prize, X72 (triennial) : On Melancholia. 4. Barbier prize, X120 : To be given to the discoverer of a reliable remedy for some disease hitherto considered as incurable. (No award.) Amongst the prizes actually awarded we find1. Civrieux prize, .660: On Nervous Vertigo. Dr. Max Simon, of Aumale (Seine inferieure). 2. Capuron prize, X40On Sudden Death in the Puerperal State. Dr. Mordret, of Le Mans (Sarthe). 5. On Saline Mineral Waters, .640. Drs. Petrequin and Socquet, of Lyons.
A prize diferreil is the following : 4. Argenteuil prize (sexennial), £ 480 : For Improvements in the Treatment of Stricture of the Urethra. 1’tvezaty essays have been sent in ; the committee cannot finish their labours till December, 1858. To the official vaccinators, to medical men appointed to watch and report upon epidemics, and to the inspectors of
20
watering establishments, numerous prizes, as well as gold and silver medals, have likewise been awarded. At the conclusion of the report on prizes, M. F. Dubois, the secretary of the Academy, read the panegyric of Magendie. This panegyric turned out to be a very severe critical examination of the professional life of the great physiologist; and so pointed were the strictures, that a relation of Magendie has thought it his duty to publish, in the different medical papers of France, an indignant letter on the subject. In his exordium, M. Dubois says, after having acknowledged that Magendie revived experimental physiology,Ishall be obliged to speak of Magendie as professor at the College of France, and of the kind of teaching he carried on in that institution ; also of his doctrines, or rather complete absence of upon which absence he prided himself. I shall be obliged to mention how great was his dislike for every kind of reasoning, and his contempt for the assistance of a reflecting mind in scientific pursuits. I shall be obliged to bring Magendie before you as physician to the Salpêtrière and the H6tel Dieu, and show you into what strange scepticism, and also complete inefficiency, his exclusive attention to the physical phenomena of life at last made him fall." And fully did the orator keep his word, following the subject of his panegyric through the whole of a long career, principally filled by experamental researches in physiology. The picture has the defect of one-sidedness, since hardly any of the incontestably useful results of Magendie’s labours are dwelt upon. Incidentally, M. Dubois mentioned two anecdotes referring to the United States and to this country. The first alludes to a Pennsylvanian quaker, who publicly reproached Magendie, in his own lecture-room at Paris, with his (to the quaker’s mind) unjustiiiablecrueltyto animals. The second relates to Magendie’s visit to this country, and to the attack made in the House of Commons against the vivisections practised in London by the French physiologist. M. Dubois is extremely careful to do full justice to Sir Charles Bell respecting the latter’s beautiful discovery of the different properties of the anterior and posterior roots of the spinal nerves, and reduces to very little the light thrown by Magendie on the functions of the cranial nerves by his wellknown intra-cranial sections performed in 1824, carefully mentioning that Fodere, in 1822, had already performed the same kind of sections. Altogether, we have, in M. Dubois’ discourse, the partial verdict of a vitalist on a physiologist perhaps a little too much rivetted by the merely physical phenomena of life.
I doctrines,
Correspondence. "Audi alteram Mrtem."
SPECIAL
HOSPITALS.
To the Editor
of THE LANCET. profession have, during the last
SIR,—The public and the thirty years been indebted to
THE LANCET for the exposure and correction of many an abuse. This debt will be increased two-fold if you can succeed in checking the monstrous And growing evil of the multiplication of " special hospitals" for the treatment of almost every medical and surgical ailment. That hospitals specially devoted to the reception and treatment of patients suffering from certain forms of disease are required every one will readily admit, and the only question is to what complaints should they be confined. It may, I think, be answered, that they should be limited to the reception of patients labouring under diseases that require either a greater amount of special skill in their management than men engaged in the general practice of the profession can be expected to attain, or to cases that are usually excluded from the wards of general hospitals. Thus, the peculiar delicacy of manipulation required in operations upon the eyes; the complexity of the apparatus necessary for the treatment of deformities of the limbs, and the exclusion of patients labouring under phthisis or small-pox from many general hospitals, more than justified the establishment of such institutions as the Ophthalmic, the Orthopaedic, the Consumption and Small-pox Hospitals-institutions that, from their magnitude, their utility, and the character of their officers, are an honour to the profession and to the country. But what reason can justify the establishment of special institutions for the treatment of fistula, of diseases of women, or of urinary complaints?-a hospital for stone, stricture, bladder
and prostate disease being generally understood in surgical circles to be in an embryonic state, to be developed-with a full staff, already self-elected-in all probability in the course of the next season. It cannot be pretended that, as in the case of consumption and small-pox, the doors of our general hospitals are closed against patients suffering from these common complaints. On the contrary, they are usually sought out, and very readily admitted by hospital surgeons. Nor will it, I presume, be contended that the introduction of a catheter, or an operation for fistula or piles requires so large an amount of special surgical skill that the ordinary run of surgeons cannot do justice to such important cases. Why, Sir, there is not a simpler and easier class of operations in the whole range of surgical practice than those required for rectal diseases, often demanding less skill than does the extraction of a tooth; and yet the public are led to suppose that it is only at St. Mark’s that surgeons are in this respect up to the mark ! So with regard to diseases of women and urinary affections, cannot every accoucheur treat the one, and every hospital surgeon the other ? and what necessity can there be to inveigle patients to special institutions, when in every hospital in London there is a maternity charity in full operation, and in most of them surgical beds unoccupied for want of funds ? The real reason for the establishment of such institutions is not that the profession requires them, or that they are called for by any defect in our already existing hospitals, but it lies deeper than this : it is that they may benefit directly and pecuniarily their professional originators by leading the public to believe that they, and they only, are the men who are competent to treat the " speciality" that the particular hospital professes to relieve. In this way the whole profession is lowered in the eyes of "the public, and its competency to treat certain common diseases called into question, in order that the few men who are connected with these institutions may obtain a monopoly of practice, each in his own special department. There cannot be the least doubt in the mind of any one who is acquainted with the state of the medical profession in London, that the special institutions to which I allude, have been, or are about to be established, for the direct personal advantage of the individuals connected with them But, Sir, the evil, damaging as it is to the general body of the profession, does not rest here. You have in last week’s LANCET most ably shown how the establishment and multiplication of such special institutions diverts funds from the general hospitals, and wastes the money subscribed for the support of the specialists by an enormous expenditure on the non-professional staff, which is maintained by each. There is, however, an evil connected with such institutions even of greater magnitude than this-viz., their interference with the means of affording proper clinical instruction to the pupils of our general hospitals. In order that the metropolitan schools of medicine be maintained in a proper state of efficiency, it is absolutely necessary that as large a number as possible of varied cases should be brought under the observation of the pupils. The establishment of special hospitals interferes most seriously with the supply of cases of many forms of disease to the general hospitals connected with the medical schools, and if their continued and almost indefinite increase be not checked, the clinical teachers will be left with little else than cases of dyspepsia, fractures, and sore legs, to illustrate their lectures; and who can say how soon some enterprising practitioners, in emulation of the rectum doctors, or the would-be urinary specialists, may deprive them even of these scanty supplies, by taking the stomach, when in difficulties, or the bones, when broken, under
their special care ? Whether we regard special hospitals as established to benefit certain individuals at the expense of the rest of the profession; as diverting the funds from, and thus crippling, the utility of
general hospitals; or as absorbing patients, and thus limiting the means of clinical instruction at our schools of medicine, they should, savein certain exceptional cases, be discountenanced by the profession, as damaging to its dignity, to its resources, and to its advancement. Finally, should a public need for the institution of a special hospital ever be manifested, let the appointment be thrown open to the profession; let them our
be conferred on the best men that can be found ; and let no nominations to office be parcelled out amongst the originators of the jcb before even the embryo institution " has a local habitation and a name."-I am, Sir, your obedient servant, A LONDON SURGEON. December, 1857.
** The writer of the above letter is a distinguished hospital surgeon, and teacher of surgery. His opinions on the subject are entitled to grave consideration.-SuB-ED. L.
ON THE TEACHING OF SURGERY IN EDINBURGH, AND MR. MILLER’S POSITION IN THE HOSPITAL. To the Editor of THE LANCET.
SIR, -In answer to "M. D.," in your journal of the 19th: December, I must observe that his notions are somewhat pecu. liar.
How anyone
can
say, " In every other medical school
teaching of surgery is held to be of importance; here, seemingly, it is not;" and at the same time pretend to be seeking in vain after surgical knowledge, when Mr. Syme’s wards contain at least eighty beds, and he lectures twice a week clinically (not in the " seemingly," London sense, but with the subject before him, referring to the features of the case as presented at the moment of speaking), I do not understand. Either your correspondent, knowing the facts I mention, has made a maliciously ignorant sneer at the Edinburgh school, or, not knowing anything whatever about the arrangements in Edinburgh, is therefore unfitted to make comparisons between it and " every other medical school." I strongly suspect M.D." ’s knowledge of "every other medical school" is about as great as his acquaintance with the surgical clinic of Edinburgh. For my part, I maintain that an honest and impartial examination of the Edinburgh arrangements will show that in the
"
Great Britain, at least, there is no other school of clinical sur--gery. Let it be understood what I mean by clinical teaching. I am not a graduate of Edinburgh, or in anyway connected with it; I have not, like "M.D.," had opportunities of comparing it with "every other medical school;" but I have studied at Paris and Berlin, and there only have 1 seen anything like Mr. Syme’s clinic. M.M. Nélaton and Langenbeck are the teachers I mean; and I ask any London man if we have anything in London to compare with Langenbeck’s clinic ?’ Nelaton’s, Langenbeck’s, and Syme’s are the only three ’’ regular clinics" I know, and I use the word entirely in the sense they do, attaching the strict sense of the word to it. I am perfectly aware how many more men there are in Paris who can and do give a "clinic," truly so called; but where to go, in London, to see a clinic, such as it is understood at the chief medical schools of the continent and in Edinburgh, I do not know, and shall feel obliged if you, Sir, can afford me, as a. stranger, any information on the subject. Now, Sir, with reference to Mr. Miller’s grievance: I havebeen compelled to put it aside till now, in consequence of the necessity I feel of showinghow absurd is’’ M. D."’s charge against the medical school in Edinburgh. That the professor of surgeryshould, ex officio, be an acting surgeon to the hospital, no onedenies. Mr. Miller is so. Where, then, is the grievance ? A Miller was content with twelve beds--Scarpa. greater than How does " M.D." propose to give Mr. Miller more accommodation ? Does he mean to diminish Mr. Syme’s accommodation ? With all respect to Mr. Miller’s claims, I think most will agree with me that it would be an unmitigated evil for the teaching of surgery if Mr. Syme’s field were reduced. Such would be the answer of the students on the spot. Then there remains the accommodation granted to the Extra- Academical School: is it fair that they should part with some of their beds? I think so, but that is a matter of arrangement in nowise connected with the 9,61e surgery plays in Edinburgh medical education. The fact is, it is impossible to do more than is done in the present state of the funds of the hospital. That twelve beds are better than none Mr. Miller believes : that he should have more is desirable; but in bringing it about, one must set to it with a little more knowledge of the hospital than "M.D." has. I can see no hardship in shutting the wards when Mr. Miller is not in the active exercise of his functions as professor. "M.D." says he cannot teach with twelve beds only. I doubt that; but am certain he cannot teach when there is no one to be taught, as in the vacation. So long as Mr. Miller lectures, he is charged with a service. Where is the hardship, then, when the reason for his being attached to the hospital no longer exists ? Yours faithfully, IMPARTIAL. Brompton, Dec. 1857. _______________
PREMONITORY DIARRHŒA IN CHOLERA. To the Editor of THE LANCET. SIR,—In THE LANCET of December 19th I observed
a
letter
from Dr. Macloughlin, in answer to a previous communication by Dr. Elliot on the subject of premonitory diarrhoea in cases of cholera. I have not seen Dr. Elliot’s article, and therefore the remarks I am about to offer may probably have been anti-
21
Foreign Department. ANNUAL MEETING OF THE ACADEMY OF
MEDICINE, PARIS. much animation pervaded the
ON the 15th of December last, hall where the members of the Academy generally meet, being the day fixed for the annual award of prizes, and the delivery of the accustomed panegyric on a departed member of the
learned
society.
As to the rewards granted in France for medical investigations and essays on various subjects, we have only to repeat what we have stated at various periods before-viz., that such incitements to exertion in the several branches of medical science, are considerably more numerous in France than in our country ; a circumstance which explains the scientific activity of our neighbours, We cannot help remarking, however, that Great Britain has, in the al seace of diJ’ect encourzzrgemezat, contributed in an admirable manner to the elucidation of medical questions, and to the introduction of valuable adjuncts to actual
practice.
It will be interesting to inquire of what nature are the questions upon which the various committees, appointed by the Academy, did not feel justified in awarding the actual prize ; merely granting sums of money (equal in amount to that offered for the prize) as encouragements to authors. In this manner we can judge of the weak points amongst onr neighbonrs. The prizes not awarded were the following :1. Prize of .640, given by the Academy: " Settle, by clinical facts, the degree of utility of issues, in the treatment of chronic
diseases."" 2. Portal
prize of X40"Point out the organic changes produced by rheumatism, and indicate the characters by which they can be distinguished from the changes occasioned by other
causes." (No essay was sent in.) 3. Lefevre prize, X72 (triennial) : On Melancholia. 4. Barbier prize, X120 : To be given to the discoverer of a reliable remedy for some disease hitherto considered as incurable. (No award.) Amongst the prizes actually awarded we find1. Civrieux prize, .660: On Nervous Vertigo. Dr. Max Simon, of Aumale (Seine inferieure). 2. Capuron prize, X40On Sudden Death in the Puerperal State. Dr. Mordret, of Le Mans (Sarthe). 5. On Saline Mineral Waters, .640. Drs. Petrequin and Socquet, of Lyons.
A prize diferreil is the following : 4. Argenteuil prize (sexennial), £ 480 : For Improvements in the Treatment of Stricture of the Urethra. 1’tvezaty essays have been sent in ; the committee cannot finish their labours till December, 1858. To the official vaccinators, to medical men appointed to watch and report upon epidemics, and to the inspectors of
20
watering establishments, numerous prizes, as well as gold and silver medals, have likewise been awarded. At the conclusion of the report on prizes, M. F. Dubois, the secretary of the Academy, read the panegyric of Magendie. This panegyric turned out to be a very severe critical examination of the professional life of the great physiologist; and so pointed were the strictures, that a relation of Magendie has thought it his duty to publish, in the different medical papers of France, an indignant letter on the subject. In his exordium, M. Dubois says, after having acknowledged that Magendie revived experimental physiology,Ishall be obliged to speak of Magendie as professor at the College of France, and of the kind of teaching he carried on in that institution ; also of his doctrines, or rather complete absence of upon which absence he prided himself. I shall be obliged to mention how great was his dislike for every kind of reasoning, and his contempt for the assistance of a reflecting mind in scientific pursuits. I shall be obliged to bring Magendie before you as physician to the Salpêtrière and the H6tel Dieu, and show you into what strange scepticism, and also complete inefficiency, his exclusive attention to the physical phenomena of life at last made him fall." And fully did the orator keep his word, following the subject of his panegyric through the whole of a long career, principally filled by experamental researches in physiology. The picture has the defect of one-sidedness, since hardly any of the incontestably useful results of Magendie’s labours are dwelt upon. Incidentally, M. Dubois mentioned two anecdotes referring to the United States and to this country. The first alludes to a Pennsylvanian quaker, who publicly reproached Magendie, in his own lecture-room at Paris, with his (to the quaker’s mind) unjustiiiablecrueltyto animals. The second relates to Magendie’s visit to this country, and to the attack made in the House of Commons against the vivisections practised in London by the French physiologist. M. Dubois is extremely careful to do full justice to Sir Charles Bell respecting the latter’s beautiful discovery of the different properties of the anterior and posterior roots of the spinal nerves, and reduces to very little the light thrown by Magendie on the functions of the cranial nerves by his wellknown intra-cranial sections performed in 1824, carefully mentioning that Fodere, in 1822, had already performed the same kind of sections. Altogether, we have, in M. Dubois’ discourse, the partial verdict of a vitalist on a physiologist perhaps a little too much rivetted by the merely physical phenomena of life.
I doctrines,
Correspondence. "Audi alteram Mrtem."
SPECIAL
HOSPITALS.
To the Editor
of THE LANCET. profession have, during the last
SIR,—The public and the thirty years been indebted to
THE LANCET for the exposure and correction of many an abuse. This debt will be increased two-fold if you can succeed in checking the monstrous And growing evil of the multiplication of " special hospitals" for the treatment of almost every medical and surgical ailment. That hospitals specially devoted to the reception and treatment of patients suffering from certain forms of disease are required every one will readily admit, and the only question is to what complaints should they be confined. It may, I think, be answered, that they should be limited to the reception of patients labouring under diseases that require either a greater amount of special skill in their management than men engaged in the general practice of the profession can be expected to attain, or to cases that are usually excluded from the wards of general hospitals. Thus, the peculiar delicacy of manipulation required in operations upon the eyes; the complexity of the apparatus necessary for the treatment of deformities of the limbs, and the exclusion of patients labouring under phthisis or small-pox from many general hospitals, more than justified the establishment of such institutions as the Ophthalmic, the Orthopaedic, the Consumption and Small-pox Hospitals-institutions that, from their magnitude, their utility, and the character of their officers, are an honour to the profession and to the country. But what reason can justify the establishment of special institutions for the treatment of fistula, of diseases of women, or of urinary complaints?-a hospital for stone, stricture, bladder
and prostate disease being generally understood in surgical circles to be in an embryonic state, to be developed-with a full staff, already self-elected-in all probability in the course of the next season. It cannot be pretended that, as in the case of consumption and small-pox, the doors of our general hospitals are closed against patients suffering from these common complaints. On the contrary, they are usually sought out, and very readily admitted by hospital surgeons. Nor will it, I presume, be contended that the introduction of a catheter, or an operation for fistula or piles requires so large an amount of special surgical skill that the ordinary run of surgeons cannot do justice to such important cases. Why, Sir, there is not a simpler and easier class of operations in the whole range of surgical practice than those required for rectal diseases, often demanding less skill than does the extraction of a tooth; and yet the public are led to suppose that it is only at St. Mark’s that surgeons are in this respect up to the mark ! So with regard to diseases of women and urinary affections, cannot every accoucheur treat the one, and every hospital surgeon the other ? and what necessity can there be to inveigle patients to special institutions, when in every hospital in London there is a maternity charity in full operation, and in most of them surgical beds unoccupied for want of funds ? The real reason for the establishment of such institutions is not that the profession requires them, or that they are called for by any defect in our already existing hospitals, but it lies deeper than this : it is that they may benefit directly and pecuniarily their professional originators by leading the public to believe that they, and they only, are the men who are competent to treat the " speciality" that the particular hospital professes to relieve. In this way the whole profession is lowered in the eyes of "the public, and its competency to treat certain common diseases called into question, in order that the few men who are connected with these institutions may obtain a monopoly of practice, each in his own special department. There cannot be the least doubt in the mind of any one who is acquainted with the state of the medical profession in London, that the special institutions to which I allude, have been, or are about to be established, for the direct personal advantage of the individuals connected with them But, Sir, the evil, damaging as it is to the general body of the profession, does not rest here. You have in last week’s LANCET most ably shown how the establishment and multiplication of such special institutions diverts funds from the general hospitals, and wastes the money subscribed for the support of the specialists by an enormous expenditure on the non-professional staff, which is maintained by each. There is, however, an evil connected with such institutions even of greater magnitude than this-viz., their interference with the means of affording proper clinical instruction to the pupils of our general hospitals. In order that the metropolitan schools of medicine be maintained in a proper state of efficiency, it is absolutely necessary that as large a number as possible of varied cases should be brought under the observation of the pupils. The establishment of special hospitals interferes most seriously with the supply of cases of many forms of disease to the general hospitals connected with the medical schools, and if their continued and almost indefinite increase be not checked, the clinical teachers will be left with little else than cases of dyspepsia, fractures, and sore legs, to illustrate their lectures; and who can say how soon some enterprising practitioners, in emulation of the rectum doctors, or the would-be urinary specialists, may deprive them even of these scanty supplies, by taking the stomach, when in difficulties, or the bones, when broken, under
their special care ? Whether we regard special hospitals as established to benefit certain individuals at the expense of the rest of the profession; as diverting the funds from, and thus crippling, the utility of
general hospitals; or as absorbing patients, and thus limiting the means of clinical instruction at our schools of medicine, they should, savein certain exceptional cases, be discountenanced by the profession, as damaging to its dignity, to its resources, and to its advancement. Finally, should a public need for the institution of a special hospital ever be manifested, let the appointment be thrown open to the profession; let them our
be conferred on the best men that can be found ; and let no nominations to office be parcelled out amongst the originators of the jcb before even the embryo institution " has a local habitation and a name."-I am, Sir, your obedient servant, A LONDON SURGEON. December, 1857.
** The writer of the above letter is a distinguished hospital surgeon, and teacher of surgery. His opinions on the subject are entitled to grave consideration.-SuB-ED. L.
ON THE TEACHING OF SURGERY IN EDINBURGH, AND MR. MILLER’S POSITION IN THE HOSPITAL. To the Editor of THE LANCET.
SIR, -In answer to "M. D.," in your journal of the 19th: December, I must observe that his notions are somewhat pecu. liar.
How anyone
can
say, " In every other medical school
teaching of surgery is held to be of importance; here, seemingly, it is not;" and at the same time pretend to be seeking in vain after surgical knowledge, when Mr. Syme’s wards contain at least eighty beds, and he lectures twice a week clinically (not in the " seemingly," London sense, but with the subject before him, referring to the features of the case as presented at the moment of speaking), I do not understand. Either your correspondent, knowing the facts I mention, has made a maliciously ignorant sneer at the Edinburgh school, or, not knowing anything whatever about the arrangements in Edinburgh, is therefore unfitted to make comparisons between it and " every other medical school." I strongly suspect M.D." ’s knowledge of "every other medical school" is about as great as his acquaintance with the surgical clinic of Edinburgh. For my part, I maintain that an honest and impartial examination of the Edinburgh arrangements will show that in the
"
Great Britain, at least, there is no other school of clinical sur--gery. Let it be understood what I mean by clinical teaching. I am not a graduate of Edinburgh, or in anyway connected with it; I have not, like "M.D.," had opportunities of comparing it with "every other medical school;" but I have studied at Paris and Berlin, and there only have 1 seen anything like Mr. Syme’s clinic. M.M. Nélaton and Langenbeck are the teachers I mean; and I ask any London man if we have anything in London to compare with Langenbeck’s clinic ?’ Nelaton’s, Langenbeck’s, and Syme’s are the only three ’’ regular clinics" I know, and I use the word entirely in the sense they do, attaching the strict sense of the word to it. I am perfectly aware how many more men there are in Paris who can and do give a "clinic," truly so called; but where to go, in London, to see a clinic, such as it is understood at the chief medical schools of the continent and in Edinburgh, I do not know, and shall feel obliged if you, Sir, can afford me, as a. stranger, any information on the subject. Now, Sir, with reference to Mr. Miller’s grievance: I havebeen compelled to put it aside till now, in consequence of the necessity I feel of showinghow absurd is’’ M. D."’s charge against the medical school in Edinburgh. That the professor of surgeryshould, ex officio, be an acting surgeon to the hospital, no onedenies. Mr. Miller is so. Where, then, is the grievance ? A Miller was content with twelve beds--Scarpa. greater than How does " M.D." propose to give Mr. Miller more accommodation ? Does he mean to diminish Mr. Syme’s accommodation ? With all respect to Mr. Miller’s claims, I think most will agree with me that it would be an unmitigated evil for the teaching of surgery if Mr. Syme’s field were reduced. Such would be the answer of the students on the spot. Then there remains the accommodation granted to the Extra- Academical School: is it fair that they should part with some of their beds? I think so, but that is a matter of arrangement in nowise connected with the 9,61e surgery plays in Edinburgh medical education. The fact is, it is impossible to do more than is done in the present state of the funds of the hospital. That twelve beds are better than none Mr. Miller believes : that he should have more is desirable; but in bringing it about, one must set to it with a little more knowledge of the hospital than "M.D." has. I can see no hardship in shutting the wards when Mr. Miller is not in the active exercise of his functions as professor. "M.D." says he cannot teach with twelve beds only. I doubt that; but am certain he cannot teach when there is no one to be taught, as in the vacation. So long as Mr. Miller lectures, he is charged with a service. Where is the hardship, then, when the reason for his being attached to the hospital no longer exists ? Yours faithfully, IMPARTIAL. Brompton, Dec. 1857. _______________
PREMONITORY DIARRHŒA IN CHOLERA. To the Editor of THE LANCET. SIR,—In THE LANCET of December 19th I observed
a
letter
from Dr. Macloughlin, in answer to a previous communication by Dr. Elliot on the subject of premonitory diarrhoea in cases of cholera. I have not seen Dr. Elliot’s article, and therefore the remarks I am about to offer may probably have been anti-
21