MEDICAL JURISPRUDENCE AND ITS STUDY

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    physiology, embracing the structure and growth of cells andof the tissues they form, the diffusion, osmosis, and absorp-tion of fluids, the assimilation of food, the metabolism ofthe tissues, with separate chapters on the Growth andMovements of Plants, on Reproduction, the Seed andGermination, and the Resistance of Plants to UntowardInfluences. A notable feature of the treatise, which isindicative of a deep underlying improvement in the educa -tion of the student, is that it commences with a chapterdevoted to the histological appliances required for theexamination of plants, including instruments, media,reagents, staining agents, and the best means of mountingspecimens ; whilst it ends with a series of practical exercises,which the student will do well to follow. All this showsthat the student is no longer expected to accept the wordsof the master on trust, but that he is supposed to see thingsfor himself, to verify statements, and to make himselffamiliar, not with an account, however accurate, given byanother man, but with the objects themselves. This is theonly true way to learn, and by which a student can becomefitted for the prosecution of scientific botany. All thosepreparing for the higher examinations, and all who areinterested in plant life, may read this volume with pleasureand profit.

    Outlines of Practical Histology: a Mantial for Students.By WM. STIRLING, M.D., Sc.D. With 344 Illustra-tions. London : Charles Griffin and Co., Exeter-street,Strand. 1890.WE can confidently recommend this small but concisely

    written and admirably illustrated work to students. Theywill find it to be a most useful and reliable guide in thelaboratory, or in their own room. All the principalmethods of preparing tissues for section are given withsuch precise directions that little or no difficulty can befelt in following them in their most minute details. Inspeaking of the spinal cord, for example, Professor Stirlingbegins by describing the mode in which it should behardened, and the principal features that should be noticedby the student, and then gives successively the methods ofstaining by Weigerts hmatoxylin method, with Biondisfluid, with benzo-azurin, with nitrate of silver after theplan of Golgi, and with Pals method, in each case givingthe strength of the solutions and the special points towhich attention should be directed. No less than elevenforms of microtome are described, Dr. Stirling apparentlygiving the preference to Minots and to Roys form asmodified by Malassez, and to the Cambridge Rocking micro-tome. The account of karyokinesis, though brief, containsall that need be known. Here, as in most other sections,additional exercises are given, treating of mitosis in theomentum of the newborn rabbit, mitosis in the amnion,and an account of the method of Martinotti and Resegotti.In regard to mitosis in the amnion he recommends thatafter the rat is killed the uterus is to be excised and placedin a saturated watery solution of picric acid. The uterusand membranes around each ftus are then to be opened,and the hardening process allowed to continue for twenty-four hours. The tissues are next to be washed well inwater, and hardened in the various strengths of alcohol,beginning with 70 per cent. ; or the washing in water maybe dispensed with. Then a portion of the amniotic mem-brane is to be selected, and a small part of it tinged inEhrlichs acid hmatoxylin, diluted one-half. The memobrane may also be hardened, he adds, in Flemmings fluid,and stained with saffranin. Specific directions for themanufacture of the different staining agents, and particularsof all the instruments required, are given in the first part ofthe work. The volume proceeds from a master in his craft,and is a credit to Owens College.

    New Invention.STETHOSCOPE WITH ROTATORY CHEST-PIECE.

    I THIS instrument, which comprises an ingenious modifi.cation invented by Mr. uoryof Bournemouth, may be re-garded as one step further inthe evolution of the stetho-scope, which was so happilysketched by Dr. Wilks in thesepages a few years ago. Theinvention consists in such analteration of the chest-pieceof the binaural stethoscope asto permit of its direction beingaltered so that it can bereadily adapted to the chestwall in almost any positionof the patient, without incon-venience to the auscultator.It will be observed also thatmuch more metal enters intothe construction of the chest-piece than usual, whilst theglobular expansion at the junc-tion of the lateral portions,where the hinge movementtakes place, facilitates ratherthan impedes the transmis-sion of sound. Careful com-parative trials have convincedus that the stethoscope is

    I equal to any in its conductivity of sound.

    MEDICAL JURISPRUDENCE AND ITS STUDY.To the Editors of THE LANCET.

    SIRS,My experience as an examiner in this subject isthat medical students treat it very lightly, and a study ofmany cases reported in the public papers shows that medicalpractitioners regard it with little care. Nothing can bemore gratifying to our profession than the confidence whichis placed in ns by the general public ; and, upon the otherhand, nothing can be more annoying than the scant respectpaid to medical evidence by judges and juries. This wantof respect to medical evidence can be laid only at our owndoors. The first law of evidence is a clear testimony as tofacts, and not to opinions. There can be no more painfulreading than the vague, uncertain, and unsatisfactoryevidence often given in court by medical witnesses. Whatis required of us is that we examine our case carefully,form an opinion justified by the facts of the case, andfinally state the conclusions which these facts justify insimple and clear language, being at the same time ready tosupport them by a detailed statement if necessary. Sucha course as this, universally followed, will do a greatdeal to give weight to our evidence, and to restoreconfidence in our opinion. The failure to do this dependsupon ignorance; and this is the more inexcusable becausethere is no real difficulty in acquiring a knowledge ofmedical jurisprudence. Books of the first excellence are,easily to be acquired. I hope, Sirs, that you may be ableto find room for my letter, and that it may bring the im.portance of the subject more prominently before us.

    I am, Sirs, your obedient servant,

    Crawshawbooth, Manchest

    J. L. KERR, M.B.,Examiner in Medical Jurisprudence and in Chemistry,

    University of Aberdeen.July 22nd, 1890.

  • 181NURSING IN THE LONDON HOSPITALS.

    THE LANCET.

    LONDON: SATURDAY, JULY 26, 1890.

    IT will be seen from a report which we publish in anotherpart of this impression that a Commissioner of THE LANCEThas been for some months past engaged in collectingmaterials, by correspondence with the nurses of theLondon hospitals, for the discussion of the conditions underwhich their work is carried on. At the time when thiswas put in hand there was no immediate prospect of any.official inquiry such as has been since undertaken by theHouse of Lords Committee. To some extent, there-fore, private effort has been superseded ; but, notwith-standing this, we think it will be found that nosmall interest attaches to the report of our Commis-sioner. In the first place, the materials here collectedhave been derived from a wider field than has yet been,covered by the evidence tendered to the Lords Com-mittee, which has as yet dealt exclusively, so far as thenursing arrangements are concerned, with one institution.And, further than that, the evidence tendered at West-minster is so very conflicting that few, we fear, will findleisure and interest to read it through, and fewer still.ability to collect any very clear ideas from the perusal.Our Commissioner, on the contrary, is able to present

    within a small compass a very large part of the casefor the nurses, and, moreover, to add suggestions forthe improvement of their condition which will, we hope,receive the careful consideration of all hospital authorities.The point to which in this preliminary statement atten-tion is chiefly drawn is that of the prolonged hours of dutyof which nurses universally complain. That periods vary-ing from twelve to fourteen hours at a stretch are excessiveperiods of toil admits of no dispute. If the work of thellurse were always what it certainly often is-work,that is to say, which permits no appreciable inter-mission of physical labour during the working time-such hours could not be borne. At other times, however,the exigencies of the ward work permit the nurse to takeher duties easily, and to rest her limbs while maintaining,3, sufficient watch over her patients. Under these condi -tions long hours do not involve any excessive strain, and itis doubtless this circumstance which has caused the mis-chief of long hours, when consumed in pressing andarduous work, from being clearly recognised and effec-tually corrected. The problem of applying a remedyis one which it will certainly tax the administrativeability of the governing bodies to solve. Some ofthe nurses, as will be seen from our report, echo thedemand of other toilers for an eight hours day. Thatsuggestion in its crude form is, we regret to say, im-practicable. To reduce by one-third the hours of duty ofevery nurse would involve the employment of three personsin the place now filled by two. The consequent outlaywould certainly, as our Commissioner points out, be

    beyond the means of the hospitals. But we quiteagree that it does not follow from this that the admittedgrievance of the nurses must be left unredressed. Asubstantial improvement may be practicable even ifthe change which some desire and all would welcomebe in its full measure impossible. The plan of keepinga staff somewhat in excess of the demands of thework upon the basis ordinarily accepted at the presenttime is one which has been practically adopted in someinstitutions, and, we believe we may add, with verysatisfactory results. Probably its efficiency would beincreased by applying it systematically, and that a prac-ticable system is possible we make no doubt. We hope,then, that in this respect, at least, the attention whichis being given at the present time to questions con-nected with nursing will result in the general adoptionof some scheme by which the personal tax of nursingwork may be diminished, and the reasonable complaints ofthese often overworked women may be silenced by theeffective remedy of their grievance.The report deals with several other matters which will

    not, we are sure, escape the attention of those concerned.For bad cooking there can be no excuse. Nothing butinattention on the part of those finally responsible for theconduct of affairs can ever explain the existence of sounmistakable and easily detected a defect in the housekeep-ing department. This is a complaint which, as one wouldsuppose, is directed against particular institutions, and doesnot affect the metropolitan hospitals as a whole. If thepeccant authorities could be identified, we think that publicopinion would be hard upon them. And certainly notwithout reason. It must in the nature of things be thatthe profession of a nurse will make large demandsupon those who follow it. That the disadvantages of theposition should be aggravated by such a wholly unnecessaryhardship a,s the want of proper, or of properly prepared,food is, where it exists, a piece of unpardonable neglect.

    IN a paper contributed to the last annual meeting ofthe Sanitary Institute, Surgeon-Major BLACK discusses themeteorology of the seaside, a topic which may appropriatelyengage our attention at the present season. His observa-tions were conducted at Brighton, Hastings, Havre, andBoulogne, and his general conclusion is that the climate ofthe English Channel seaboard as compared with that ofLondon is characterised by " more ozone, more breezes,more showers, more sun and air, and less heat, less calms,less smoke, and less miasmata." Ozone was found to bemost abundant in the mornings during the prevalence ofsouth-westerly winds, but in settled weather there was moreozone in the afternoons, as the ordinary sea-breezes springup at that time after mild mornings. Evaporation wasfound to be more active on the coast than inland, as mightbe expected from the prevalence of wind. The generalbreeziness of the coast climate was strongly borne out bythe observations. There-were seventy-seven mornings andseventy-eight afternoons with some wind, as compared witheight calm mornings and seven calm evenings. The mostprevalent wind was that from the south-west, the next infrequency being northerly winds, characteristic of anti-

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