The same end-the prevention of suffering-has also been attained in another way, to which some allusion has already been made, viz. the simplification of the modes of dressing the wounds caused by surgical operations. The improvement in this respect has been gradual. The cumbrous dressings and often torturing applications of our remote forefathers, the boiling pitch into which the amputated limb was plunged, or the heated iron by which the surface of the recent wound was seared, had long been banished from use; but the dressings were still too complicated, and the mode of closing the larger blood-vessels by ligature inevitably prevented the early healing of the wound, by leaving between the two surfaces foreign bodies, the ligature threads and particles of dead and putrid matter, the extremities of the blood-vessels, detached by the pressure of the ligatures. The very recent discovery of acupressure-a discovery for which we are indebted to the illus trious discoverer of chloroform-has to a very great extent removed both these obstacles to the speedy healing of surgical wounds. By needles of suitable size and length passed either through the external skin over the vessels to be closed, and again brought out through the skin, or applied in other ways which need not here be described, pressure is made on the arteries; the lips of the wound are then brought together by metallic sutures, an immense recent improvement, and further closure is effected by a few strips of isinglass plaster; the limb is then placed in a suitable position, with due provision for its immobility, and, with the exception of the withdrawal of the needles after the lapse of a few hours, or at the most a day or two, and after a longer interval the removal of the wiresutures, the treatment is complete. Nature does all the rest. There is, say those who have extensively tested this mode of dressing, no sloughing, no suppuration, no absorption of pus, and consequent surgical fever; there are no painful dressings repeated daily for, perhaps, weeks. To use the words of a speaker at the late annual meeting of the British Medical Association in Dublin, "If surgeons are strangely apathetic as to the desirability of attaining such results, patients are not equally so. I was lately told by a medical friend of the case of a gentleman who had a tumour, some time ago, removed in Edinburgh, and who, after being operated upon, was weeks in getting well. After returning home, he happened to get hold of a book on acupressure, by Dr. Pirrie, and after reading it, angrily argued with his ordinary attendant, my informant: Why was I tortured for six weeks to please old surgical prejudices, when I might have been cured in a day or two?"

The illustrations we have so far given of the recent improvements in the art of medicine have been drawn from one branch of it, that, viz. which deals with external diseases and injuries. But in the treatment of the ailments more especially coming under

the care of the physician, results equally great in the aggregate, although, perhaps, not individually so splendid, have been produced. The most valuable, perhaps, of these has been increased confidence in the efficacy of drugs. The remark was long since made, by whom first we know not, that the mind of every practitioner who thinks for himself, and is not content to be guided merely by routine, passes through three stages. In the first stage he has unbounded confidence in medicines. In the second, disappointed by the non-realization of the brilliant dreams of his youth, he doubts their efficacy altogether. In the third stage, that of mental maturity, he believes that, judiciously administered in accordance with the teachings of enlightened empiricism, they can do a great deal. The professional mind, as a whole, has within the last halfcentury gone through a similar series of changes. But a few years since it appeared to be sinking into a hopeless condition of scepticism as to the utility of strictly medicinal treatment. A brighter age has happily succeeded. A discriminating confidence in the powers of remedies of proved efficacy has taken the place both of doubt and of blind faith in all drugs; and here again the duty of relieving pain, and of avoiding unnecessary suffering, has been recognized. It has come almost to be a fundamental principle that in nearly all diseases, acute or chronic, of which pain is a prominent symptom, to relieve the pain is to cure the disease, and that therefore, wherever narcotics do no harm in other ways, they ought to be administered. Modes of giving them otherwise than by the mouth have in consequence been devised, and one of those is so ingenious and so elegant, if the expression is admissible, as to be worthy of description. By means of a little syringe, having a nozzle drawn out into a minute pointed tube, perforated like the fang of a rattlesnake a little way below its extremity, a few drops of concentrated solution of morphia are injected under the skin, so as to come directly into contact with the extremities of the nerves of the painful or inflamed part. To quote a portion of one of the many recent professional utterances now lying before us, "We see neuralgia of long standing cured by one injection of morphia; we see the same treatment visibly restoring to health congested vessels of the conjunctiva; reducing unnatural heat, not of the whole body, but of a suffering portion of it; lessening the swelling of an inflamed joint; arresting vomiting, depending on a lacerated brain, or upon peritonitis, or suppressed menstruation."*

The hypo-dermic administration of medicine has not been limited to morphia. Other vegetable alkaloids have been given in the same way. The most promising results thus obtained have been when

* Mr. T. P. Teale, jun., Opening Address at the Leeds School of Medicine. -British Medical Journal, Oct. 5.

two powerful remedies, which in their operation on the brain and nervous system are antagonistic to each other, such as morphia and atropia, the active principle of belladonna, are injected simultaneously. The headache and phantasms of atropia have been found to be controlled by morphia, as well as the partial deafness and the visual defects of the former alkaloid. Conversely the drowsiness and stupor caused by morphia disappear under the use of atropia. In other respects the two remedies thus administered have been found to be mutually antidotal.*

Who knows how many lives of persons poisoned by opium, and too far narcotized to be capable of swallowing, may be saved by the subcutaneous administration of atropia?

To these triumphs in the cause of humanity something must still be added. It must often occur to the earnest-minded practitioner that in the exercise of his calling he is treading in the steps of his Divine Master, whose chief work on earth was to heal the mental and bodily diseases of those who came to Him.

But the physician now, if it may be said without irreverence, goes beyond his Master, although he is only following out the natural developments of his Master's teaching.

To use the words of an eloquent and popular writer:-" No man who loves his kind can in these days be content with waiting as a servant upon human misery, when it is possible in so many cases to anticipate and avert it. Prevention is better than cure, and it is now clear to all that a large part of human suffering is preventable by improved social arrangements. When the

sick man has been visited, and everything done which skill and assiduity can do to cure him, modern charity will go on to consider the causes of his malady, what noxious influence besetting his life, what contempt of the laws of health in his diet or habits, may have caused it, and then to inquire whether others incur the same dangers, and may be warned in time. Christ commanded his first followers to heal the sick and give alms, but He commands the Christians of this age, if we may use the expression, to investigate the causes of all physical evil, to master the science of health, to consider the question of education with a view to health, the question of labour with a view to health, the question of trade with a view to health, and, while all these investigations are made, with free expense of energy and time and means, to work out the re-arrangement of human life in accordance with the results they give."t

In justice to the faculty of medicine be it said, that some of its members were among the first to recognize these great truths. Biennial Retrospect of Medicine and Surgery for 1865-6.'-New Sydenham Society, p. 460. tEcce Homo,' 4th edition, pp. 196, 202.

Happily they do not now stand alone. The exertions of a small band of zealous men, continued through many weary years, have at length succeeded in placing Preventive Medicine in something like its proper position in the estimation of the profession and of the general public. It is now seen to be as much the duty of our rulers to care for the Public Health, as to make provision for the peace and the material prosperity of the community.

Within the last few years several Acts of Parliament bearing upon Public Health, each on the whole an improvement on its predecessor, have been passed, and the last of them, the 'Sanitary Act of 1866,' requires only, to make it almost perfect, that some of its enactments, now permissive, should be made compulsory.

In other countries also the subject is attracting attention. have lately seen an assemblage of diplomatists met, not to divide conquered provinces or to obviate threatened war, but to prevent, if possible, another invasion of Europe by the pestilence which had already three times ravaged many of its cities and towns.

These are encouraging facts, but to make our condition perfectly satisfactory much has yet to be done. We want a Government Department of Public Health, presided over by a single responsible head. We want travelling inspectors, constantly at work, to anticipate local outbreaks of preventable disease, and not to be sent down only when such outbreaks have occurred. We want medical officers of health in every registration district, and we want a higher status and more power for the medical officers in the three great public services, the Army and Navy and that of the Poor Law. Recent events have shown the miserable consequences of the disregard of the advice of military and naval surgeons, and the country would have been spared the shame and the sorrow of the recent revelations of the condition of the workhouse infirmaries, metropolitan and provincial, had the medical officers been placed in a more independent position, and had the Poor Law Board trusted rather to their reports than to those of inspectors too often incapable or careless. Thanks to the non-official inspections organized by the proprietors of the 'Lancet,' and more recently by the British Medical Association, a better state of things has already been inaugurated in the metropolis, and improvements will, it is to be hoped, follow in the provinces.

Before concluding, we wish to direct the attention of our medical readers especially to one mode of preventing disease, to which some of them, it is to be feared, are not yet sufficiently awake. Too many of the buildings designed for the reception and treatment of poor persons suffering from various ailments or accidents, by their very construction, generate maladies far more dangerous than those they are designed to cure. We believe that there is not a public hospital in the kingdom, built before the Crimean War, which is

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not unfit for its purpose-which does not kill many of those it ought to cure. Surgical fever, or Pyæmia, is the bane of general hospitals; puerperal fever, of obstetric institutions. Small are the chances, more especially at certain seasons of the year, of the man whose leg has been smashed by a railway accident or similar casualty, and who undergoes amputation in an old-fashioned hospital. Far better would it be for him to be treated in a hovel on a bleak hillside, or under a tent. In like manner, the poor women who in their hour of sorrow have to depend on public charity, have far better chances if attended in their own comfortless homes, than in many a luxuriously furnished maternity hospital of the old construction. The conviction of these truths has recently led to the proposal to abolish hospitals altogether, and to substitute for them clusters of cottages which shall accommodate one, or at most two, patients in each room. Happily we need not make a change so sweeping and likely to be attended with so many inconveniences.

Hospitals built on the pavilion system, carried out in its integrity, may have as pure an atmosphere as a detached cottage, and the medical officers of the older hospitals, who do not with all possible urgency strive to impress upon those in authority the duty of rebuilding their hospitals on the improved plan, will assuredly incur a grave responsibility. The example has been set in the Herbert Hospital, in the new St. Thomas's, and in the new infirmaries at Leeds, and some other places, and it is to be hoped that it will be universally followed.

VII. FARADAY.

ON the 25th day of August, 1867, a spirit passed away from amongst us, leaving a gap amidst the noble few, who have, by the powers of their intellectual industries, placed themselves in the position of being the rulers,-the instructors, of mankind. All that remained of Faraday was laid in the earth at Highgate, on the 30th of the same month, without display, without parade, and the busy world, involved in the circles of its joys and cares, appeared to be little conscious of the extinction of a light, by the aid of which it had been advanced into some of the recesses of Nature, and gleaned a few of those truths which alone are capable of giving man power over matter.

With a strange inconsistency the world applauds with enthusiasm the doings of the warrior, the influences of whose labours are often the chaining of truth, the reinvigoration of vice, and the perpetuation of ignorance amongst men. The appreciation of his greatness is shown by recording in enduring bronze, above his ashes,