TINNED-WIRE STILETTES.

955 Amerimn Journal of Syphilography and Dermatology, the only scientific journal published in the English language devoted exclusively to skin and venereal diseases. It continues to afford valuable assistance to those who give

New Inventions.

RESPIRATOR FOR USE AFTER TRACHEOTOMY. attention to these classes of disease, and, to our DR. ARNiso, of Newcastle-on-Tyne, has designed a in similar in a than the journals mind, greater degree respirator to be attached to the front of a tracheotomy tube. is further the aim of but it and The respirator is intended to obviate the risk of pneumonia, France, Italy, Germany; the editor to so enlarge its field of usefulness as " to serve as which is one very fertile cause of death after tracheotomy, and is probably caused by breathing air which has not a communication between the specialist .... and those in general practice." Dr. Bulkley has been fortunate in the been warmed and moistened by traversing the natural airmany able collaborators who have assisted him in his passages on its way to the lungs. It is on the principle of endeavours, and we are glad to see that two of the younger the ordinary respirator, and consists of six circular plates of English dermatologists, Mr. Morris and Dr. Colcott Fox, fine wire gauze enclosed in a box. The box slides into a have now been added to his stsff-the former taking the rim which projects from the front of the neck-plate, and it duty of digesting the recent literature of the anatomy and is so made as to be easily removed, not only by the surgeon physiology of the skin, and the latter therapeutics and such or nurse, but also by the patient himself if he should find general topics as medicinal rashes, statistics, baths and any impediment to breathing through fouling of the plates. We hope the "Archives"will meet The lid of the box (an open ring) takes off and the plates mineral waters, &c. with the support it deserves amongst British practitioners. can be taken out and cleaned, being quite free and not attached to each other. It has been tried on a patient of Dr. Drummond in the Newcastle.on-Tyne Infirmary, and it The Life and the Poetical Works of John Critchley Prince. was not found necessary to clean the plates oftener than By R. A. DOUGLAS LITHGOW, LL.D., M. R. C. P. Edin., once in two or three days. A disc of carbolised gauze In three Volumes. Manchester : Abel catches F.R.S.L, &c. any discharge coughed up, and so prevents fouling. Heywood and Son. London : Simpkin, Marshall, and It is evident that the respirator cannot be used where there Co. 1880. is persistent cough with expectoration, which would rapidly WE ought sooner to have noticed this work, and we foul the plates. It is only adapted to cases where cough is can only do so now with much more brevity than we absent or comparatively quiet, in which it may probably be could wish. The work has this double interest for us, that or relieved by breathing warm air, moisture being prevented it contains the record of a human life which, despite its The tube is the ordinary a steamer as usual. by supplied poverty and its sins, has great and beautiful lessons ; and, tracheotomy tube, and is made in two sizes, one respirator secondly, that the life is written, and the poems are edited, fitting both. The respirator has been made for Dr. Arnison by a member of our profession, with a sympathy and an ap- by Messrs. Weiss and Son. The only suggestion we would preciation of genius which are never more fitly placed than offer is that it would be an improvement if the box and plates in the medical man, to whom nothing is foreign that is could be made still lighter than they are, so as to lessen the: human. To take time from a busy professional life to write of the respirator. weight the life of a working man, born in 1808, who thought himself a poet, and wrote poems that fill two considerable volumes, MESSRS. SOUTHALL BROS. AND BARCLAY’S is not a proceeding that would commend itself to all medical SURGICAL APPLIANCES. But Dr. Lithgow has so done his work as to lay all men. THE above firm are the manufacturers of some very useful lovers of poetry and all lovers of men under considerable materials for surgical purposes. They prepare a Dextrinised obligation. We should, indeed, have noticed these volumes Millboard which is sold in strips and angles; it is very light weeks ago but for the fact that whenever we have taken and firm, and yet brittle enough to be easily broken iuto them up we have found a sort of fascination either in the required lengths. When soaked in boiling water it becomes poems themselves or in the life of Prince as told by Dr. pliable in a few moments, and is then readily moulded to a Lithgow. Prince was undoubtedly a poet of no mean part, and quickly again becomes hard, forming a very light, genius, and, though he struggled with poverty such as cleanly, and sufficiently rigid splint. We have also made working men nowadays know or need know little of, a trial of their Antiseptic Pads, formed of absorbent cottonthis very poverty and struggle enhance the value of wool enclosed in absorbent gauze, and the whole impregnated his poetry and our admiration of it. We commend his with salicylic and carbolic acids. Their absorbent power is poems and Dr. Lithgow’s "Life" to our readers-the one for extremely valuable, and they are a very simple and cleanly their beauty, their melody, and their healthiness of senti- dressing for open and discharging wounds. They are made ment, and the other for its great sympathy and its truthful of various sizes, and some are well adapted for the lying-in narration of a life too common in its misery, but too rare in room. The Antiseptic Absorbent Bandages may be useful the thoughts and faculties by which even misery is elevated in some particular cases. Of Southall’s Antiseptic Elemi Plaster or Hospital Strapping we can only say that after a and mitigated. fair trial we have found it superior to any we have hitherto met with. It is pliable, adheres without heat or ,5yllab?tsqf J[aterict 11Iedica for the Use of Students, Teachers, moisture, is cleanlyvery to use, does not crack off, and does not and Practitioners By ALEXANDER HARVEY, M.D., and ALEXANDER DYCE DAVIDSON, M.D. Fifth Edition. adhere too closely. Its antiseptic property may be of some value when applied directly to wouuds, but whether this is so London : H. K. Lewis. 1881. or not, its other excellences enable us to recommend it THE popularity of this little book is attested by the with confidence. appearance of the fifth edition. It is practically a list of the preparations of the British Pharmacopoeia, and is hufTINNED-WIRE STILETTES. ficiently compact to go into the waistcoat-pocket. It is MESSES. SAML’EL LAW & SONS have submitted to us a convenient book of reference to the practitioner, and some specimens of their fine tinned-steel-wire stilettes for we fear also a convenient cram-book for the student. The hypodermic syrine:. For strength and elasticity they far attempt to assign the relative value to different prepa- surpass those generaily supplied with the syringes, and aie rations and drugs, by means of numbers, is retained, but really of use in clearing the fine tubular needles of dirt or seems to us of very doubtful utility, giving, where it crystallised metalloid. Similar wire of larger gauges can does not mislead, no useful information. be utilised for the stilettes of catheters, &c.

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956

CLINICAL TEACHING.

explanation of this remarkable difference is that students are, nowadays, taught anatomy and physiology systematically, and have fairly good facilities for practical stully. With practical surgery and surgical pathology, on the other hand, the reverse obtains. To be present at the practical part of the pass examination for the membership is often a melancholy occupation. Many candidates seem to have LONDON: SATURDAY, JUNE 11, 1881. no notion as to how they should proceed to examine a patient. At a recent examination it was not rare to find THE high percentage of rejections at the various exami- candidates ignorant not only of the differences between nations recently held at the Royal College of Surgeons of hydrocele and orchitis, or hydrocele and hernia, splay-foot England is of grave significance and importance to everyone and suppuration of the tarsal articulations, enlarged bursa interested in medical education. Some critics (perhaps un- and periosteal swellings, or enlarged bursa and fatty tumour, successful and disappointed teachers) have indulged in but ignorant also of the methods of physical examination by angry comments on the general character of the examina- which those differences might be discovered. Whether the tions conducted by the authorities of the College, and have fault be his own or his teacher’8, a candidate has not been trained who cannot apply any other test to a hydrocele, or even impugned the competency of some of the examiners. This pique is, perhaps, only natural. The exigencies of the orchitis, or hernia than balancing the enlarged scrotum on the examination system drive teachers and examiners into open flat of his palm, who examines for fluctuation by proddinga and avowed antagonism. There is constant and incessant swelling with the tip of his middle finger, who is unable to strife over the merits of the pupil and candidate. Teachers apply any other test than ocular inspection to a doubtful and students, when unsuccessful, are apt to imagine that the tumour, and who does many other things that candidates atthe examiners are crotchety, capricious, and unfair, while the College are often observed to do. All this implies absence examiners, when the rejections are high, will not hesitate of practical training. There is in our medical schools no to declare the candidates are ill taught and badly prepared. lack of lectures and no scarcity of demonstrations, such as Considering that the oral parts of the examinations at the they are, but there is an urgent need of larger opportunities College are open to Fellows of the College, and to other for practical training in clinical medicine and surgery. As members of the profession properly introduced, it would, at no one can acquire skill in practical chemistry or phy tiology first sight, seem easy to discover the meaning and reason of by means of lectures alone, and without practising experithis high rate of rejections. The matter is not, however, so ments and manipulations in the laboratories, so no one can simple, because an important element is wanting. The become a skilled medical practitioner without actual personal quality of the examination and the character of the labour in the various departments of a hospital. There is examiner may be determined, and a sufficiently correct reason to fear that in straining after a transcendental pathojudgment may always be formed of the fitness of a candi- logy and an over-elaboration of physical aids to diagnosis, date, but there is no means of discovering the merits of the student is not taught the rudiments of his art. This the absent teacher whose business it has been to superintend must be patent to anyone who will take the trouble to visit the candidate’s training and education. In the hope of the College examinations, especially during the off season. We have no desire to pose as apologists for any body of obtaining some clue to the great number of rejections we have repeatedly visited the oral examinations for the examiners or any examinations, nor do we wish unduly to Membership as well as for the Fellowship, and we will disparage the candidates. We wish merely to express the state at once that we entertain a very strong opinion that in conviction based upon a large experience-namely, that as a large number of instances candidates are very imperfectly regards practical surgery and surgical pathology, the trained, and not a few have evidently undergone no sort medical student is at best but imperfectly trained, and at of preparation for examination. This is most noticeable at worst he is not trained at all. Nor will this be a matter of the pass examination for the membership, and least notice- surprise when we consider the difficulties of providing able at the first examination for the membership. The con- dresserships and clinical clerkships for all the pupils at a ditions of the Fellowship examination are peculiar, and do large school. Even at the largest hospitals there is a dearth not materially affect the question we are now considering- of clinical offices compared with the number of applicants, while at the smaller hospitals many students have practi. namely, the average education of medical students. No one, we imagine, will dispute the statement that the cally to go without dresòerships. From some hospitals many first examination, or examination in anatomy and phy- students are compelled to present themselves for examination siology, is a more trying ordeal for the young student than without any other knowledge of practical surgery than they the second, or pass examination ; and yet, as a rule, candi- have been able to acquire while writing prescriptions for the dates acquit themselves better at the first examination than out-patient surgeon, or in opening once or twice abscesses in at the final. Wewould go so far as to say that even at the connexion with impetigo of the scalp, or occasionally strappass examinations weak candidates are, usually, better ac- ping an ulcerated leg. Some remedy for this unsatisfactory quainted with surgical anatomy than with practical surgery state of things will have to be found. One way out of the and surgical pathology. Indeed, it is not uncommon to see difficulty might be to adopt a proposal made some time ago, a candidate familiar with all the superficial markings and to open up the workhouse infirmaries for clinical instruction "landmarks" of surgical anatomy, but ignorant of many to medical students. There are doubtless many drawbacks of the rudiments of practical surgery. The obvious to this plan, but probably not more than to any other. It

THE LANCET.