782

some considerations on the principles of medicinal com-bination, on incompatibility, posology, varieties of magistralformulae, concluding with a lengthy series of examples andexercises. It will be seen that the book travels along well-beaten tracks, affording few opportunities for originality oftreatment. With regard to abbreviations, it may be pointedout that the plan adopted might occasionally lead to someconfusion if the student follows the example given him onpp. 46 and 47, where P. Scammonii Composita and P. Scam-monii Compositus respectively indicate pill and powder.In the examples and exercises, which occupy nearly two-thirds of the book, an attempt has been made to classifythem according to their intended action. This portionappears to be specially valuable, the prescriptions beinggiven at full length, with the directions in Latin. It maybe questioned whether the two " cogent reasons " given bythe author for the employment of Latin still hold good:" A prescription in Latin can be deciphered in almost everyquarter of the globe; and, secondly, it is often necessary toconceal from our patient that he is taking a certain drug."Still, as a guide to the art of prescription writing whichmay prevent the " unfriendly criticism of an apothecary’sapprentice," and as a useful handbook for examinationsrequiring prescriptions in Latin, this little work wouldappear to fulfil the objects of its publication.

The Forms of Nasal Obstruction in relation to Throat andEar Disease. By GREVILLE MACDONALD, M.D. London :Alexander P. Watt.

THESE lectures exhibit a considerable command of a

complex subject. Where many specialists have in their

writings made confusion worse confounded, Dr. MacDonaldhas attempted, and we think with success, to make mattersplain. His classifications are good and his explanationslucid, while his deductions from clinical observations are inmost cases underlaid by an accurate substratum of patho-logical reasoning. The literary style of his lectures suffersfrom his failing to readjust constructions applicable to thelecture theatre, but unsuitable for the pages of a manual.The formulae at the end of the book are too scanty to be ofreal use, and the frequent references to the Throat HospitalPharmacopoeia are tantalising, since that valuable manualis not always at one’s elbow. An appendix of the prepara-tions referred to would be a boon to the general practitioner,and would enhance the value of the book. Dr. MacDonald

appears to belong to the many who regard the evidence asunsatisfactory for believing in necrosing ethmoiditis. Theanatomical explanations of the nose and the post-nasalregion are remarkably good, and the same may be said ofthe therapeutic portions of the book. Dealing with amatter with which the general practitioner is but little

acquainted, Dr. MacDonald has supplied materials foraccurate diagnosis and prompt and effectual treatment, andin such a way as to be within the grasp of those who haveno special training in the kind of work treated of in the book.

ROYAL MEDICAL BENEVOLENT COLLEGE.

THE twenty-fourth biennial festival of this institutionwas held on Tuesday at the Hotel Métropole, the Lord Mayorpresiding. Among the guests were his Royal Highness theDuke of Cambridge, the Earl of Dartmouth, Sir Trevor

Lawrence, M.P., Sir A. Clark, Sir T. Crawford, Sir E.

Saunders, Sir E. Sieveking, Sir A. Watson, Dr. Holman, andother prominent members of the profession, as well as theSheriffs of London and Middlesex.The Duke of Cambridge, in responding for "The Army,

Navy, and Reserves," remarked that he was glad to be ableto say that the services were as efficient as they could be,but that was not intended to imply that they were asefficient as they ought to be. For a powerful and influen-

tial nation lilre ours the services ought to have the means tosecure still greater efficiency. The present times were

marked by difficulties and anxieties, and it was impossibleto forsee from day to day-he might almost say fromhour to hour-what might happen. It was not a time toshut our eyes to our own shortcomings, but rather to keepabreast with progress and to advance with the times.Neither the military nor the medical professions shouldallow their interests to be dealt with on the basis ofparty spirit. They were the common interest of all, andhe was very glad to be present on that occasion to supportso useful an institution as the Royal Medical BenevolentCollege. Without the aid of the medical profession thearmy could not exist, not only in times of war but also intimes of peace, because they looked to the medical staff tokeep the men in fighting condition. It was his most earnestendeavour, as it was his bounden duty, to secure cordialrelations between the various branches of the service, becauseit was only in that way that the general efficiency of thearmy was promoted and the safety of the country secured.The Earl of Dartmouth responded for the House of Lords,

and Sir Trevor Lawrence, M.P., for the House of Commons.The Lord Mayor, in proposing the toast of the evening,

said he feared the laity in general knew too little of thestruggles and difficulties of medical practitioners, but hecould assure them that the work of the Medica1 BenevolentCollege was most urgently needed, and most efficientlyconducted. In behalf of the widows and orphans of themedical profession, he earnestly asked for liberal support.

Dr. Holman having responded to the toast, a list of sub-scriptions and donations, amounting to £2570, was announcedby the secretary, and the proceedings shortly after terminated.

New Inventions.ALLEN’S PATENT HOT-WATER AND ICE BOTTLES,THESE bottles are of various shapes, to allow of con.

venient application to chest, abdomen, head, or knee.

They are certainly very superior specimens of tin ware,and are made in two pieces instead of the usual four, thus

minimising the danger of leakage, whilst the seams ar6-well rounded and finished. The vessels are all supplied withloops, so that they may be suspended by tapes from the bedcradle, These bottles must prove of value in the sick room.

783ROYAL COLLEGE OF SURGEONS.—A QUESTION OF MEDICAL ETHICS.

THE LANCET.

LONDON: SATURDAY, APRIL 21, 1888.

THE Minutes of the quarterly meeting of the Council ofthe Royal College of Surgeons, held on April 12th, 1888,will naturally be scanned by Fellows and Members, with aview to present information and a hope of seeing somemark of future improvement in the conduct of collegiateaffairs. The election of the Morton Lecturer, the award ofthe Jacksonian Prize, and the admission of two Membersto the twenty-years’-standing Fellowship, are items of

information which will, doubtless, meet with the approvalof the general body of the profession. The reference of the

subject of granting of degrees in Medicine and Surgery to aRoyal Commission will be generally accepted as the bestsolution of a pressing yet wide-reaching difficulty. In the

two reports-(1) on the delivery of lectures at the College,and (2) on the form of Report of the Council to the annualmeeting of Fellows and Members, respectively-datedApril 3rd and llth we had hoped to witness some sign offuture improvement in the conduct of collegiate affairs;but "as you were" is the order of the day, and reformersmust chafe yet a little longer. The Report on the deliveryof the College lectures pleads for a further trial of the

present system of giving lectures in the College, andstates that it "has been to some extent suscessful." When

matters are at their worst they begin to mend. In the

opinion of many persons, the proper way to popularisecollegiate lectures is to awaken an interest in the Collegeherself ; her danger lies in the apathy of her alienated con-stituents. A distinguished surgeon delivering (as of late)in the College theatre a lecture on a subject which he hasmade peculiarly his own, to an audience of ten persons, isnot an edifying spectacle. In this case the fault was cer-

tainly not the lecturer’s. Let us hope that the suggestedplan of delivering the lecture at 5 P.M. instead of 4 P.M.may do something towards filling the rows of emptybenches. The Report of the Committee on the form of theReport of the Council to the annual meeting of the Fellowsand Members of the College, which was read, approved, andadopted, faithfully represents the Council of the College inits favourite r6le. Improvement is to be effected by thesimple expedient of shuffling the cards, the pack remainingthe same. The Report, in its present crude form of an

abridged copy of the Minutes, will be presented. The

Fellows and Members of the Royal College of Surgeons willhave further opportunity of exhibiting their legislative im-potence and political weakness by an unavailing protestagainst the actions of a governing body alike indifferentand irresponsible. Seriously, it is lamentable that a body ofgentlemen, who are in other respects fitting representativesof British surgery (as the members of the Council of theCollege of Surgeons undoubtedly are), should manifestsuch an inaptitude for political ideas by continuingto exclude the Members of its corporation from anyreal share in its management,, and by perpetuating the

anomaly of denying the right and privileges of Membershipto the great majority of the body politic and corporate.The membership of all other learned societies carries withit well-known privileges-such as the right of voting atannual and other general meetings, this vote exercising adirect and specific power over the executive. The Councilof the College of Surgeons, after the application of theirown intellectual and other tests, solemnly certify to theMember’s skill and attainment; but it would seem that

, his capacity is for matters outside his own College, andL not inside.

It is well that members of our profession, thoughignored by the Council of their own College, and bereftof its sympathy, do win public confidence and esteem

! in the wider sphere of daily duty, and that many of the

rising members are thus strengthening the argument inl favour of their just enfranchisement.

v CASUISTS of all epochs have delighted to discuss the

; question whether it is always and under all circumstancesI incumbent upon us to speak the whole truth, the majority, of moralists leaning to the view that a rigid adherence tol literal accuracy of speech cannot invariably be demanded

without serious danger of thereby creating a worse evil, than that which it is thus sought to avoid. No case is

; more pertinent to this issue than that of the physician, who! is often at a loss how far to impart to a patient or hisr friends the precise import and future probabilities of disease! as they appear to his mind. It is easy for those who are

l destitute of actual experience to enlarge upon the virtue ofl candour and the advantages of knowing the precise truth;! but practical men know that the question is beset with very! real and formidable difficulties, and that it is not to be

decided offhand by any obvious enunciation of moral plati-. tudes. So strong are the reasons for desiring a generally

hopeful spirit on the part of medical practitioners that a dis-tinguished consultant of a past generation is said to have once

! avowed the opinion that a very bad prognosis should never. be given-a dictum which cannot be conscientiously approved,L but is worthy of note as showing how much a great mind. was impressed with the motives which impel us to avoid

doing aught by word or act to quench the last ray of hopeor discourage the last effort put forth for the relief of the

i dying. On the other hand, we cannot help recognising the. justness of the rebuke when the novelist or satirist depicts. the medical attendant leaving the sick bed with cheery

words, easily interpreted (by the patient at least) as indica-. tive of a strong hope of recovery, and no sooner closing the

door of the sick room than bluntly avowing that death isimminent. Such conduct, although no doubt often basedon humanitarian principles and real kindness of heart, doesmuch to lower the moral status of the profession, and is onevery ground to be strongly deprecated. We propose to

glance at a few of the difficulties of this nature which con-stantly arise in practice.

Cases like the following are of daily occurrence: -A patientwho has been ailing for some time, but who has no suspicionof grave impending mischief, presents himself for examina-tion, and is found to be suffering from cancer or advancedphthisis. No one who knows anything of human naturewill advise that in such cases the physician should bluntly