Reviews. DISEASES OF THE HEART. BY EDMUND H. COLBECK, B.A., M.D. (Cantab.), M.R.C.P.(London), D.P.H. (Cantab.), Physician to Out-patients at the City of London Hospital for Diseases of the Chest, Victoria Park, E., etc., etc. With forty-three illustrations. (London: Methuen & Co., 36 Essex Street, W.C. 1901. Price 12/-) The author, in his preface, makes a graceful allusion to his former teacher, Sir William Broadbent, to whom the book is dedicated. This book contains many valuable facts concisely arranged, and throughout it can be traced the influence of his early training under Sir William Broadbent. An excellent short outline of the anatomy and physiology of the heart are given in the first two chapters, though of the accuracy of the figure on page 7 we are not convinced, the right auricle appearing to us to be situated higher than normal. The methods of diagnosis are treated with much detail and care, but we should have wished for some observations upon the value of radiography. Pericarditis, myocarditis, and endocarditis are considered in separate chapters, but the picture of rheumatic carditis is by this arrangement to some extent spoiled. Over-much stress is laid upon pericardial effusion, and the dilatation which is so constant, and depends upon myocardial damage, is placed too much in the background. It is very doubtful whether it is advisable to deal with rheumatic carditis under the headings to pericarditis, endocarditis and valvulitis. The use of the term infective endocarditis is hardly advisable, since the general feeling of the profession is that rheumatic fever must be the result of an infection, and, therefore, the endocarditis which occurs is necessarily infective also. The criticism that we would make of this useful book is, that in endeavouring to avoid controversial matters, the author has in places somewhat failed to keep the book in touch with the more modern views. There can be no doubt as to the care, labour, and detail that has been employed in the work before us, and the author has admirably succeeded in writing of diseases of the heart, with especial reference to the mechanical principles that underlie them. Appointments. ASHDOWNE, W., F.R.C.S., appointed Demonstrator of Anatomy in the Medical School, vice A. W. Sanders, M.D., B.S.(Lond.), F.R.C.S., resigned. MARTLEY, F. C., M.D.Cantab., M.R.C.P.I., appointed Anæsthetist to the Steeven's Hospital, Dublin. UNIVERSITIES, ETC. Second Examination of the Conjoint Board. H. C. CLAPHAM, H. FENTON, W. FINLAYSON, SOCIETY OF APOTHECARIES. Final Examination. Surgery: H. de T. Barber. (Sect. 1.) The Diploma of the Society has been awarded to Messrs. R. A. JONES, A. U. PARKHURST, A. H. THOMAS, and L. G. W. TYNDALL. The Services. INDIAN MEDICAL SERVICE. Capt. CLAYTON A. LANE, I.M.S., has been appointed F. W. Sumner, M.B., B.C.Cantab., passed 5th out of Netley, and was awarded the Fayrer Prize in Pathology. H. R. Nutt, M.B.Lond., passed 6th. SOUTH AFRICAN WAR. Civil Surgeon E. A. NATHAN, M.D., B.S.Lond., has been discharged from hospital to duty. The following have been appointed Civil Surgeons for service in South Africa : A. U. PARKHURST. A. H. THOMAS. L. G. W. TYNDALL. Change of Address. J. JACKSON CLARKE, to 18, Portland Place, W. G. R. ELWIN, to 186, Blackfriars Road, S.E. G. D. MAYNARD, L.R.C.P., M.R.C.S., to Roche, R.S.O., Cornwall. P. B. SPURGIN, L.R.C.P., M.R.C.S., to 180, Merton Road, Wimbledon, S. W. L. REYNOLDS, L.R.C.P., M.R.C.S., to Ablington House, St. David's Road, Southsea, Hants. E. R. CLARKE, B.C.Camb., L.R.C.P., M.R.C.S., to 4, York Crescent Road, Clifton, Bristol. Guy's Hospital Gazette." "Middlesex Hospital Journal." "St. George's Hospital Gazette." The Broadway." "The Hospital." "The Nursing University College Gazette." "University of Durham College of Medicine Gazette." "St Thomas's Hospital Gazette." "St. Bartholomew's Hospital Gazette." Magazine of the London (Royal Hockey as a Winter Pastime. Now that St. Mary's has started a Hockey Club in earnest, and the inevitable "pot" is in the near future, the time has come to say a few words about this game as a winter pastime. Some games, like some people, are the victims of unfortunate names. Who among us could hold his head high when announced as "Mr. Bugg"? or what portly matron could sail majestically into a drawing room when a stentorian voice exclaims "Mrs. Tuckin!"? Cricket has, indeed, conquered this disadvantage of a weird name, but Hockey, we believe, still suffers from the effect of its christening. In spite of this, the game is surely coming to the front, and now it is played so much around London, that a few words upon its merits and demerits may be of interest to our readers. Let, then, some bold and knowledge - seeking reader start with us for Waterloo on a Saturday afternoon, as, armed with a cricket-bag and hockey-stick, we seek that pandemonium. Bold he must be, for small boys will shout after us encouraging remarks on the subject of walking-sticks. Old gentlemen will jump up in the railway carriage and demand the meaning of the strange weapon, and its handle, as you push your way to the station, will get into people's stomachs, and they will object. Once on the ground, all is well. It must be a flat one, preferably a cricket or tennisfield; a rough piece of turf is dangerous and detestable. This is one great difficulty about the game, for a good, flat ground is Price 6d. length and breadth, than an Association football ground, and the goals, though similar, are also smaller. There is one great difference, a feature distinctive to the game. In front of each goal there is painted a white semi-circle, within which the ball must be taken before a shot can be made at the goal; this is known as the striking circle. The ball is an ordinary cricket ball coated with white paint, and several are necessary, for they soon get dirty. Eleven play on each, and side that hits most goals is called the winner. The players are arranged exactly as in Association football, five forwards, three half-backs, two backs, and a goal-keeper. Two important rules, and enough of detail. The stick must not he raised above the shoulder: nor is there need to do so, for they "drive" with even more force than a cricket bat. You must also play with the face of the stick. If made of ordinary material, provide yourself with shin-guards and wear gloves, and, if many depend upon you, then insure-and you are quite ready to make a start. You won't like the game the first few times you play it. It is very quick and dodgy; but don't do as two new men we once met did. We were busy sewing up a cut on the leg when they unfortunately arrived, and, catching sight of the blood, remarked "This is no game for us!" and vanished. It is certainly a little dangerous if not played well, but, as the doctors in general practice remark, after an experience extending over twenty years, except for a few bony swellings over the shins, a crushed rapid dentistry, we have observed no ill effects, and can safely affirm that we have done more than this for others. Some nasty cuts over the face, some broken fingers, and one death are about the extent of the casualties on record. Compare this with football, and ask how many knees have been wrenched for life; how many limbs broken; and how many people kicked in the stomach with fatal results? It is less dangerous than most winter games; and all, we are glad to say, are dangerous-for it would be cold work otherwise. The great merit of the game is that there is no charging. You may stop the ball with your hand, but you may not push or kick a man off the ball; the great danger of getting wrenched is thus avoided, and this, when it is impossible to get into strict training, is a God-send. On the other hand, let no one think it is an easy game. It requires a good eye, quickness, endurance, and some pluck. "Passing" is reduced to a fine art, and it requires long practice and a good eye to reach perfection. It should not, and will not, in our opinion, supersede football, but it fills a great gap for men who may have injured a knee, and dare not risk the charging of football, or who cannot keep in the very best training. It is quite a different game to golf, with which it cannot be compared, for it is of a different class. It is first-rate practice for the cricket season; it is played by many good athletes; there are no pro.'s" or "pots"; and there are many good clubs round London. 66 Ladies play Hockey, very nicely too; but we leave it to one of them to write upon this-it would be an impertinence upon our part. A few lines upon mixed Hockey games, and we have done. They are highly dangerous for the unfortunate males, for though they are afraid of injuring their fair opponents, the latter brandish their hockey-sticks regardless of life and limb. After it is all over you will want beer to steady your nerves, and will only get tea. On the other hand, it is another means of affording what are tactfully called "opportunities," and if previously unaware of this, The Introductory Address By G. WILLIAM HILL, M.D.Lond., Surgeon for Diseases of the Ear to the Hospital. We are confronted to-day with the spectacle of a number of young men entering on an expensive course of study extending over at least five years, in the hope of eventually joining the ranks, and making a competence in the ranks of a profession already overcrowded. The total number of entrants at the various medical schools in the kingdom we may put down as at least two thousand; and one may well pause to enquire whether these women and young men are wise, and whether it is really worth while going to the trouble and expense of a medical education at all. Why not start off and practise on the credulity of the public, without let or hindrance by law? We live in an age when there is not only a large survival from the dark ages of superstition, and a belief in occultism and in quackery of all kinds in medicine, but there is positively a revival of the most alarming character of an emotional form of occultism, a jumble of pseudo-science and irreligion. I allude to the various forms of faith-healing, of which Christian Science is a type. There is, of course, money in the movement. A series of superstitions and extravagant systems are conspicuous in the antecedents and bypaths of the history of medicine, and are related to it much as astrology is to astronomy, or alchemy to chemistry; and, because medicine in part remains, and to previous generations was conspicuously an empirical art rather than a science, it offers great opportunity for practical error misapplied partial knowledge. The legitimate recognition of the importance of mental conditions in health and disease is one of the results of the union of modern psychology and modern medicine. An exaggerated and extravagant, as well as pretentious and illogical overstatement and misstatement of this principle may properly be considered as "occult." "Divine healing" exhibits its success in one notable instance, in the establishment of a school and college, a bank, land and investment association, a printing and publishing office, and sundry "divine healing homes; and this prosperity is now to be extended by the foundation of a city or colony of converts, who shall be united by the common bond of faith in divine healing as transmitted in the personal power of their leader. The official organ of this movement announces that the personification of their faith "makes her religion a business and conducts herself upon sound business principles," and their leader publicly boasts of his vast financial returns. With emphatic protest on the part of each that he alone holds the key to salvation, and that his system is quite original and unlike any other, comes the procession of Metaphysical Healer and Mind-Curer, and Viticulturist, and Magnetic Healer, and Astrological Health Guide, and Phrenopathist, and Medical Clairvoyant, and Esoteric Vibrationist, and Psychic Some use or abuse the manipulations of hypnotism others claim the power to concentrate the magnetism of the air and to excite the vital fluids by arousing the proper mental vibrations, or by some equally lucid and demonstrable procedure; some advertise magnetic cups, and positive and negative powders, and absent treatment by outputs of "psychic force," and countless other imposing devices. truth, they form a motley crew, and with their "colleges of fine forces," "psychic research companies," offering diplomas and degrees for three weeks' course of study or the reading of a book, represent the slums of the occult. An account of their methods is likely to be of as much interest to the student of fraud as to the student of opinion. In There can be no doubt that many of these systems have been stimulated into life or into renewed vigour by the success of Christian Science; this is particularly noticeable in the introduction of absent treatment as a plank in their diverse platforms. This ingenious method of restoring the health of their patients and their own exchequers appealed to all the band of healing occultists, from spiritualist to vibrationist, as easily adaptable to their several systems. As I am addressing a mixed audience, many of whom have had no medical training, it may serve some useful purpose if I review simply and briefly the evolution and growth of medicine in early times, with a special reference to the occult factor in ancient and modern times. In fact I am almost driven to touch somewhat on the historical aspect of this question, for in dealing with a medical subject, no ordinary person in the ordinary way, thinks of dispensing with the usual historical sketch. I have been at pains to peruse various hoary records relating to medicine and surgery before the days of Hippocrates. These records are spread over ancient Egypt, Assyria, Greece and Rome. Even by the aid of English translations, one soon realises the obscurity in which the practice of medicine was enshrouded before the time of Hippocrates, that is, about 400 B.C., but in dealing with the medical art as taught and practised by him, we are dealing with extensive, systematic and authentic records-records mostly by himself. Medicine, anterior to the "father of medicine," is not only historically speaking enshrouded in mystery, but we find that the medicine man revelled in mystery, and his practice bristled with occultism. On the other hand, exponents of occultism found a happy hunting ground in the field of medicine. The evolution of the medical art is probably contemporaneous with the development of the higher anthropomorphic attributes in man; it cannot, of course, be doubted that instinct in the lower animals leads them to abstain from, or safeguard themselves against, what might prove hurtful to their health, and instinct leads them to seek out and adopt what is likely to be beneficial. In a sense, therefore, we may allow that a kind of preventive medicine was in force previous to the evolution of man, but it may be safely surmised that curative medicine was not practised till man attained though the domestic animals in many instances show a marked appreciation of the medical and surgical aid they occasionally receive at the hands of man, we seek in vain for any general evidence of initiative on their part in the practice of either inedicine or surgery. An animal, stricken with disease, usually hides away in the nearest corner, and, if the disease is a mortal one, dies with more or less resignation. In some species, his fellows recognising his plight, will decide to put the victim out of his pain-a somewhat crude attempt at Euthanasia. Preventive medicine in man, we may safely assume, therefore, preceded the evolution of the healing art, and was coeval with the higher development of the reasoning faculty. Medicine, as a profession, is probably older than the church and the civil law: it certainly is older in superstitious traditions and ethics. The tendency to the formation of associations and societies, which is such a feature of to-day, is found in the Asclepiade of Greece, the priest doctors of ancient Egypt, the Lamas of central Asia, the Vaidhyas of India, the Druids of ancient Britain, and the Fraternities of the middle ages. In very early times, however, the profession of medicine was rarely practised alone, and was usually combined with the priesthood; this combination was even continued so recently as the early and middle ages of Christendom, where the good and holy monks where not only largely concerned with the production, maintenance and dissemination of literature and science, but included within their ranks the doctors: the medical missionaries of to-day are the modern analogues of the priest-physicians of old. In the articles which will appear in many of the daily papers to-morrow, you will probably find that practitioners of medicine alluded to as followers of Esculapius," or as students of the Esculapian artthese, and expressions of a similar kind, will naturally suggest to you that Esculapius was the first personage who made any great reputation as a physician. Now whether Esculapius was a real man or merely a god of the usual mythological character, is not quite clear. Hippocrates claimed to be the eighteenth in descent from Esculapius, and this would seem to settle the point that he was really a man, but you must bear in mind that a couple of thousand years before the Christian Era the College of Heralds thought nothing of tracing a man's descent back to one of the gods, especially if his liberality in the matter of fees appeared to warrant such a pedigree. Not only it is not certain whether Esculapius was a mythological personage from the start, or whether he was really a medical man and afterwards deified by the Greeks who represented him as the son of Apollo, but there is equal uncertainty as to his nationality; he has been claimed as an Egyptian by birth, and he may well have been so, as in those days the Egyptians were a highly learned nation, and Greece was early colonised by them, a compliment which the Greeks returned later. Certain it is, however, that the more immediate descendants of Esculapius formed themselves into a priesthood later known as the Asclepiadae, and they were at once places of worship, hospitals, and medical schools. Under their influence medicine became a regular profession, but in these early times internal medicine seems to have been kept distinct from surgery, the latter being usually combined with some trade-a condition which obtained even down to the last century; and the dissociation of surgery from the art of the priest-doctor may account for the undoubted fact that there has always been less occultism associated with surgery than with medicine. It is true that the dissociation of medicine and surgery was not universal, for it is alleged that Esculapius had two sons, who greatly distinguished themselves as physicians and surgeons at the siege of Troy in 1814 B.C. Whether these persons really acted as general practitioners or not is immaterial; there was no double qualification necessary in those days. There is very clear evidence that many centuries before Hippocrates (who practised about 400 B.C.) the division of labour was so great that specialism was carried to the most ridiculous extremes by the Egyptians-the priest-doctor was only allowed by law to practise one speciality; how many specialities the human body was then divided into I am not prepared to say, but every organ and every system had its special exponent apparently; we learn that those who treated fractured bones were not permitted to deal with diseases of the joints other than fractures; physicians for stomach complaints were by law debarred from treating diseases of the heart, and so on-a surgeon could not treat a patient with diseases of intestines, though he should have a first-rate knowledge of internal complaints. Fancy how galling it must have been to the surgeons of those days to have been obliged by law to hand over their appendicitis cases to the physician whose speciality was the right iliac fossa. Again, picture an otologist who was not allowed under any pretext to insert his finger into the nasopharynx of a deaf child; I am sure you cannot imagine what his feelings would be. It is satisfactory to learn, however, that these specialists had to go through a regular medical curriculum which was not confined to their own special line of business-the most gifted senior students were sent from Alexandria on a post-graduate to Heliopolis and other polyclinics, in the same way that intending specialists go to Vienna to-day. The doctors lived at Thebes in a quarter of their own, just as consultants do here. Another pleasing feature which has unfortunately no counterpart now, was that there would appear to have been actually enough Staff appointments to go round; for each medical man we learn was attached to a hospital. When medical aid was required in private practice the messenger hastened not to the Harley Street area of Thebes where the specialists resided with their families, but hied him to the nearest hospital where the "Principal of the Medical Staff of the Sanctuary," as he was called, questioned the messenger as to the symptoms from which the patient was suffering and he selected the man he thought best fitted for the job. without examining or seeing the patient and from a necessarily imperfect report of the symptoms. This attitude of mind, however, of practising physicians attaching but secondary importance to diagnosis -diagnosis made before, rather than after examination-finds a parallel in the extraordinary and illogical mental attitude of so many of the laity at the present day. Laymen of a certain type see nothing ridiculous in undertaking without any medical. knowledge to make a diagnosis of their own case, and they either consult a quack institute by letter or else seek advice through the correspondence column of a newspaper, or prescribe for themselves a proprietory or "patent medicine" from the nearest drug stores, pouring drugs of which they know little into bodies of which they know less. Diagnosis is the part of medicine where accuracy can least be dispensed with, it can least be arrived at in a haphazard and inexact way. Given an accurate diagnosis it is comparatively easy to get some idea of treatment from books, but treatment not based on diagnosis is valueless, and sometimes far from harmless. The Alexandrian doctors took no fees from the patient. Their temples were maintained by a regular share of the state revenues, by gifts from Kings, and by voluntary contributions from the laity. How Utopian this state-supported hospital system appears to us! Fancy St. Mary's Hospital receiving from the revenue instead of contributing to it! I have remarked already that before the time of Hippocrates much of the materia medica and therapeutics of the priest-doctors was kept secret. This in addition to curtailing our knowledge of their practice must have not only retarded advance, but encouraged the pernicious idea of mystery with which medicine was regarded by the laity. We can excuse those who lived 4,000 years ago when superstition was rampant, because medicine was practised by those who were also the exponents of a ridiculous theology, and when belief in the occult was universal; but it is indeed lamentable to see the most palpable heterodoxy still receiving substantial support from all sorts and conditions of men, from the castle to the cottage. Coming now to Hippocrates, we find that he lived in the best and most prosperous period of Greek ascendancy. He was born in 460 B.C., and was the contemporary of such learned men as Socrates, Plato, Xenophon, Pindar, Thucydides, Eschylus, Euripides, Sophocles, Aristophanes, and Herodotus. He was a voluminous writer, and codified the medical knowledge and traditions which had been handed down by the Asclepiads. He was not really the "father of medicine" as he is usually styled, but he was evidently, intellectually and practically, head and shoulders above his predecessors. One of his aphorisms, "Vita brevis, ars longa," has passed into the ordinary speech and literature of all nations. I cannot better indicate what manner of man he was than by reading you the oath of Hippocrates, and it will, perhaps, be more convenient to all present, not excluding myself, if I give it to you in English rather than at first hand, in the language in which it was |