Notes.

The numerous changes which have been made in the Medical Curriculum for the degrees of the University of London are of such great importance to the Medical Student in London that we make no apology for giving a prominent place to the contribution on the subject which we have received from one of the ablest of our lecturers. There are many of the changes which are likely to provoke a good deal of criticism, but the test of time will prove them, and we can at least welcome this as a distinct step in the scheme for the conversion of the University into a Teaching Body.

In the present semi-chaotic state of the University, very few people seem to have any idea of the exact definition of an Internal Student. We have not. The only thing to do, if any information be wanted, is to send up individual cases to the Academic Registrar for decision. If anyone does this the School Secretary would be glad to hear the answer, as it is well to have a record of such cases for the purpose of reference. We may say that, in answer to an enquiry, we were informed that a Student of the University at present, even though he has taken only the Old Regulation Lectures and Classes, will be granted a degree as an Internal Student; he will, however, take the Old Regulation Examination. This would hardly appear from a study of the prospectus, which seems to prescribe "Special Courses of Study" for "Internal" Degrees.

From the study of the New Regulations it would appear that the University intends to exact very strictly the full tale of attendances on Lectures and Demonstrations.

We

For the M.B., B.S., Certificates will be required for the former subjects, and in addition for instruction in Anæsthetics, Eye, Ear, and Throat work, and for 6 months Pathology and Bacteriology, to include 3 months P.M. Clerking.

We wish to call special attention to the Ceremony of Presentation of Honorary Degrees of the University to T.R.H. The Prince and Princess of Wales, and Lords Lister and Kelvin, on the 24th prox., at the Albert Hall. It is hoped that as many members of the University as possible will do their best to add to the success of the function by their presence.

Mr. Owen has been appointed Examiner in Surgery, and Mr. Pepper Examiner in Forensic Medicine, in the University of London.

We are delighted to chronicle the fact that our late Editor, Dr. Poynton, has been made a Fellow of the Royal College of Physicians. Dr. Jas. Collier was also promoted to that position at the same Comitia. We heartily congratulate them both.

Rumour has it that at Madrid Dr. Poynton read his paper in Spanish. At least, the English people who were there said it was Spanish. What the Spanish people who were there thought about it has not been recorded.

In the Lancet for the week ending Saturday, May 2nd, we noticed two papers by members of St. Mary's Hospital. The first is on the obscure subject of Acute Yellow Atrophy, a case of which is reported in its clinical aspects by Mr. W. W. Ferris. A very careful Pathological examination of this was made by Mr. Clayton Greene, and the bulk of the article is made up by his account of the histological appearances and changes in the various organs. The second article is by Dr. Luff, on the subject of "The Dietetic Factor in Health Resort Treatment." the next issue Professor Wright contributed "A Note on the Serum Reaction of Tubercle," treating specially of the Agglutination

We specially wish to mention the views. that we recently heard expressed by Professor Wright on the subject of original work in Clinical Pathology. He considers that the average student, with most of his time taken up by the acquisition of less special knowledge, or, if qualified and in the house, by the manifold duties of his office, can scarcely hope to be able to work in a sufficiently regular manner to produce a result worth his labour, or even to spare enough hours per week for the distinctly tedious and patience-trying details that such work necessarily involves. He suggests, however, that any men who are sufficiently keen on Science for itself to give up, say three or four hours a week to the joint investigation of some problem, should combine to form a Research Class. Professor Wright would be very pleased to direct its work and instruct its members in the necessary technique. We hope this notice will stimulate some men to send in their names, and that a scheme may be started worthy of our new Laboratory.

On Thursday, May 8th, Dr. Cheadle gave a special Clinical Lecture on "Acholia."

We have been asked to publish the following notice :

"For the convenience of gentlemen who wish for a light luncheon, there will be in the Club Dining Room a Special Bar, where they can obtain what they require at a very low tariff, beginning on and after the 18th inst., from 11.30 to 2 o'clock."

Pocock deserves all the support that the School can give him. He caters very well at exceedingly moderate prices, and tries to please his customers in every way. We hope that men who go in for "bun and milk" lunches will now do so on the premises, as they will be able to get what they want as cheaply as, and with less trouble than, if they went outside.

At the time of writing exactly six men have signified their intention of playing Cricket this year. Exactly six! Let us fervently hope that this list will have grown and multi

We

But as a sign of the times it is a most sad and evil fact. Three years ago we won the Cup; last year we ought to have won it, but did not; and this year we bid fair to rival the exhibition of the Football season. put it to all new men that within the memory of the present generation this was the premier hospital in athletics in London; that the Library fairly scintillated with Trophies; and that now it contains one pot, reposing "in icy isolation, chastely cold," the said pot being due to the exertions of one man, Lascelles. If anybody has any spare time, and can hold a bat or throw a ball, we appeal with all our force to him to send in his name as a playing member to the Secretary of the Cricket Club.

Does anybody intend to play Tennis this year? If so, cannot the leading lights try to get up a team to represent the Hospital? Perhaps the siren Golf has lured away all her rival's devotees, but if there is a remnant left in all the land, let them come forward, because nobody will drag them into the light of day.

We hope that by the time this GAZETTE appears, the absence of a good half of the smoky pall that hangs post-prandially over the club-rooms will betoken the rigid training of many men for the Athletic Sports. We expect Wilson to surpass his achievements of last year, and hope that the School will show us some new blood.

A challenge has been received from the Golf Club of St. George's Hospital to play them at some date in the early summer. As the St. Mary's Golf Club has not yet condensed out of its nebulous condition, the challenge still awaits acceptance, but we hope to hear before long of a victory, and to chronicle the doings of another athletic club in our columns.

We congratulate Nesfield on the successful result of a very smart piece of Chemical and Bacteriological investigation. It may not be generally known that our Unique Strut " has, entirely by himself, invented, patented,

method of sterilising drinking water of pathogenic microbes without in any way affecting its potability. This is a really excellent piece of work, and we wish him as much success from the commercial, as he has attained from the scientific point of view. If the War Office do not take it up, it will be another real cause for dissatisfaction with the present Government.

And whilst on the subject of V. B. N., we must also offer him our sympathy. That such base advantage should be taken of his well-known softness of heart by a guinea-hunting adventurer is indeed sad. We are glad to record that the specious Innocent who "had his pocket picked at Queen's Hall" and was lent a guinea to take him home, will live for twelve months at the public expense. There was something sublime in the way he trotted round London, presenting himself as our little friend, and confirming his statement with his victim's card. This and his tale of woe coaxed guineas galore from the pockets of some shining lights of the profession, till a Brompton medico, finding him unable to write a prescription for simple dyspepsia, handed him over to justice.

And the annoying part was that our H.P. rushing off to Scotland Yard to vindicate his honour, missed one of those rare two guineas that fall to the lot of a Resident Medical Officer. Altogether a most annoying congress of events, and enough to wring winged

words from a man of less coolness of mind and self-control.

We sympathise with our correspondent "Palmam qui Meruit Ferat." It is presumably necessary to keep the Prospectus within moderate limits of size, but we agree that the more recent Special Departments seem to have been given an unfair advantage in the retention of their lists of Clinical Assistants to the exclusion of the Ophthalmic Department's. We refer him for consolation to some apropos remarks of a physician of over two centuries ago, the pious and dignified author

but no less stately "Hydriotaphia "-" To be nameless in worthy deeds exceeds an infamous history. . . . But the iniquity of oblivion blindly scattereth her poppy, and deals with the memory of men without distinction to merit of perpetuity. Who can but pity the founder of the pyramids? Herostratus lives that burnt the temple of Diana, he is almost lost that built it... The greater part must be content to be as though they had not been." Even Clinical Assistants!

*

*

Act I., Scene 1.-No. 4 Room. — Enter a Mysterious Stranger, with his hands very red and swollen, and two blue marks on the dorsum of the wrists; he glances furtively around him, and says in a husky whisper to the H.P. on duty, "Will you take me in, Dorktor, I'm awful bad." H.P., after a long and thorough examination, which incidentally discloses a rash, calls in brother H.P. They both agree that the disease is rare, and send for Distinguished Physician who is on the premises. Enter D.P., who makes a long and thorough examination. D.P. (summing up): So on the whole we will consider the case to be one of Angio-Neurotic Edema, but in view of the doubtful nature. of the rash we will admit him to Isolation." D.P. goes on to suggest seeking a Surgical opinion, so Distinguished Surgeon is sent for. Enter D.S., who makes a long and thorough examination. D.S.: "Yes, a sweet case; I have seen one only before; it has certainly been described, but I cannot recollect the name." Enter 2nd Distinguished Physician, who makes a long and thorough examination. 2nd D.P.: "I don't know what it is, but I should like him in my ward to have him watched." However the Isolation idea is acted on, and scene closes on patient hurriedly and joyfully making for the lift.

Scene 2.-The top of the stairs. Enter lift with Mysterious Stranger at back. Enter an Altogether Infallible and Very Wide Awake Medical Superintendent. He makes a very long and very thorough examination of the blue lines, and remarks staccato, sotto voce, and

Act II., Scene, Isolation Ward, Time 9 p.m. Mysterious Stranger in bed. Enter Medical Superintendent and Person in Disguise. (Soft and vibrating music.) A Patient (aside to Nurse): "See that cove, I knows 'im, 'e's a tec." P.I.D. (to Med. Sup.): "Introduce me to him as another doctor." He is introduced accordingly to M.S., and takes a long and thorough look at him, then remarks, "He's our man," and retires into a neighbouring apartment to wait to escort M.S. to a free lodging.

Epilogue. From the "Daily Dial.” “M.S., a ruffianly-looking man, was charged at Street with burglariously entering a house in

Square. It appears that shortly after midnight the butler entered his pantry and found accused helping himself to the silver. The burglar made a desperate assault on him, and jumped out, hanging on to the ledge by his hands. The butler, summoning up all his strength, slammed the window down upon his wrists and then bit his finger. * * The accused, after escaping, was admitted to St.'s Hospital, where he was subsequently apprehended.

*

*

We believe that the report is false which says that the Skin Department turned up in force, and diagnosed those blue lines as Dermatatis Cerulous Fulminans, or something equally polysyllabic.

Mr. Stephens has come into the House under Dr. Phillips, and Mr. Bate has been appointed House Surgeon to Mr. Pepper.

We are glad to see Cunningham back again. After serving as Lieutenant in the Royal Irish Fusiliers throughout the late War, he has beaten his sword into a scalpel. We congratulate him on having been placed on the Reserve of Officers as Lieutenant.

Acting Sister E. Gibson has been appointed Sister of Manvers Ward, and Acting Sister M. Davies has been appointed Sister

We are very pleased to see Sister Dyson back again in Albert; she looks exceedingly well after her tour on the Continent.

The Medical, Surgical, and Hygienic Exhibitors' Association, Limited, will hold their Seventh Annual Exposition of Professional Exhibits at the Queen's Hall, Langham Place, London, W., on June 2nd, 3rd, 4th, and 5th, 1903, from 2 p.m. till 10 p.m. each day. Music by a select orchestra every afternoon and evening. We wish them the same success as in former years.

This capital story, though of the Victorian era, may be unknown to many of our readers. A certain Edinburgh Lecturer on Medicine, to explain his enforced absence, affixed this somewhat pompous notice to his lecture room door "Professor, having been summoned to Balmoral, is unable to lecture to-day." A wag wrote underneath, "God save the Queen."

A former editor sends us the following: A girl of 18, with anæmia and indigestion, was brought to Victoria Park Hospital by her mother. These are the mother's words, taken verbatim.

"Please, doctor, may I speak a word, I'm 'er mother, an' when I was five months gawn I 'ad a severe fright, an' so I took the little girl to the 'orspital, an' they said she 'ad nervous debility an' a sluggidge liver, an' please, doctor, do you think that 'as anythink to do with it?"

An excellent innovation is the posting in the Medical School of a list of the various Summer Lectures, with the names underneath each of those men who have not attended in that subject since passing their 2nd examination. We believe this is due to the energy of the School Secretary, and must have entailed a lot of trouble; however, as we all know, Mr. Matthews does not spare himself in work which leads to the simplification of our various difficulties.

We have after all struggled into print again

Case of Extraperitoneal Rupture of
Bladder.

Under the Care of Mr. H. S. COLLIER.
Reported by CHARLES BRODRIBB, M.B., B.S.

History.-A boy, aged twelve, was admitted to St. Mary's on Saturday, March 28th, at 9 p.m., suffering from an injury sustained that afternoon. The injury was caused by a piece of sheet iron falling from its support, striking him in the left loin, and throwing him violently on to his right side.

Condition on Admission.-The boy complained of pain in the right hypochondriac and lumbar regions. Examination showed his general condition to be good, pulse 64, regular, and of good volume; temperature 98. On inspecting the abdomen, it moved slightly with respiration, and there appeared to be bulging in the right loin; there was also considerable bruising over the right lumbar and hypochondriac areas and a small contusion over the left kidney area. The right side was slightly the more rigid, but there was no tenderness elicited anywhere. On percussion there was thought to be dulness in the right loin.

A soft catheter was passed and eight or ten ounces of intimately mixed blood and urine drawn off. The boy was admitted and examined again in the ward, when what was taken for bulging and dulness on the right loin had completely disappeared. The diagnosis of an intracapsular kidney lesion was made, an ice-bag applied to each loin, and the boy kept quiet. The following day his condition and physical signs were much the same. A soft catheter was again passed, and zviij. of urine, much bloodstained, were drawn off. He continued about the same during the day, and several ounces of similar urine were drawn off again that night, there being still a marked absence of any abdominal physical signs.

The following (Monday) morning the general condition of the boy was much the same, but there was more abdominal rigidity, though apparently no tenderness, and a tumour rising out of the pelvis about three fingers' breadth above the symphysis pubis in the middle line. A soft catheter was passed, drawing only about an ounce of blood and urine, and the tumour, which was taken for distended bladder, still remained. It was then thought to be distended by blood-clot from the kidney lesion. By early in the afternoon the tumour was a little larger, and by four o'clock reached nearly to the umbilicus, was exactly pyriform in outline, and not tender; nor was the boy in much pain.

Mr. Collier saw the case at this time for the first time, and advised immediate operation.

The boy was taken to the theatre and anesthetised, during which he passed one or two ounces of bloodstained urine in a fair stream.

An incision made in the middle line over the tumour showed that there was a large collection of extremely ammoniacal urine in the retroperitoneal tissue, at the bottom of which collection there was found a lineal rent in the bladder, some three inches long, running upwards and backwards from the neck. The pelvic

moniacal urine. The rent was sewn up with catgut, except where a drainage tube was inserted, and the boy put to bed and continuous drainage established.

The object in reporting this case is, of course, to consider the series of mistakes made by the writer in the early stages, and consider in what way they could be avoided. The first conclusion is that extraperitoneal rupture of bladder is difficult of diagnosis, and so in all cases of injury attended with hæmaturia, all sources at our command should be used to exclude it, however plainly the history of the injury or the present symptoms point to a kidney lesion. Of these sources the passing of a silver-not a soft-catheter with location of its beak as to superficiality, mobility, &c., in the bladder would seem of great importance; next the injection test should be tried. Again when at first the suprapubic tumour appeared, had a silver catheter been passed, the tumour would not have been taken for bladder distended with clot, and the diagnosis have been changed, and a few hours gained. The only symptoms pointing to a bladder lesion were the absence of shock, which would probably accompany a severe kidney lesion, and pain referred to the end of the penis after passing a catheter, though this latter is of small moment.

Other points of interest are the fact that he passed urine voluntarily with so large a rent in his bladder, and that several ounces of urine were drawn off easily and uninterruptedly by catheter.

As I was alone responsible for some thirty-six hours delay in operation, during which his pelvic cellular tissue was soaking in ammoniacal urine, I am extremely glad to be able to report the boy doing well, pulse 82, temp., normal, urine acid, and the patient interested in the Daily Graphic.

Lastly I have to thank Mr. Collier for permission to publish this case.

4th April, 1903.

Medicine in China.

BY ARTHUR STANLEY, M.D., B.S.Lond., D.P.H., Health Officer of Shanghai.

The native Chinese practitioner of medicine has all the unctuous self-satisfaction of the successful modern clinician as he sits among his tigers' skulls and bottles in his open shop ready to feel the pulses of the gullible. He is a specialist in plasters, and compounds the most wonderful blunderbuss prescriptions. His belief in his own powers is prodigious. The prejudices of the Chinese against Western medicine are still strong. Even when converted to Christianity by promises of extra rice, he will still have none of the foreigner's drugs; but his surgery appeals to him. The Chinese have no surgery beyond the piercing of painful parts with long needles. The Chinese are a people with an enduring belief in all kinds of drugs, charms, and spells, and their medical methods are strictly empirical, and mostly founded on the fancies of the alchemistical religion of Tao. The Chinese drug shops contain an immense number of drugs and preparations, are the