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Education on this subject is not superfluous either for the

public or the profession. Concerted action and unity ofpurpose are the essentials of success.

WORDS OF WISDOM.

To those who stand on the threshold of a medical career,whether as student aspirants or as newly-qualified prac-titioners, we would cordially recommend a perusal of Dr.

Wadham’s address delivered on the occasion of the prizedistribution at St. George’s Hospital. A practical man of theworld, and possessed of special experience as Dean of St.George’s, he refrained from anything like ideal counsels ofperfection; but we think that his sensible and humorous

essay on the art of getting on is more likely to prove helpfuland stimulating to the student than many more pretentiouslyexpressed exhortations.

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"WANDERING RASH OF THE TONGUE."

A SHORT but very careful article on "Wandering Rashof the Tongue," by Dr. J. L. Goodale, is publishedin this month’s number of the American Journal ofMedical Sciences. This condition, according to Dr.

Goodale, was first described by Parrot in 1881 and isidentical with Moeller’s " superficial glossitis," the " glosso-dynia exfoliativa" of Kaposi (though not always painful),and the "eczema of the tongue" described by De Molenesand Besnier. Occurring at any age it is, on the whole, morecommon in the young and in them usually patchy, thoughridged and furrowed in older persons. It is essentially asurface inflammation and sections show the rete mucosa tobe invaded by leucocytes, subsequent desquamation of theepithelium resulting in the formation of clear spaces, whichare again covered by epithelial ingrowth from the surround-ing area, the process tending to repeat itself, with conse-quent hypertrophy of the affected tissues. Dr. Goodale hasdiscovered no special bacterial or protozoan excitant of thisdisorder, and his inquiries tend rather to show that gastricand nervous disturbances usher in its appearance.

PATHOLOGY OF MULTIPLE SCLEROSIS.

IN the last number of the Neurologisches Centratblatt a

very important paper is published by Professor Strumpell onthis subject. The etiology of many nervous diseases hasin recent years, he says, been successfully investigated,yet about such a common disease as multiple sclerosislittle or nothing is as yet known for certain. Marie’sview that it is in most cases a sequel of acute

infectious disease can scarcely be maintained, for whereasin many cases of acute infectious disease multipleinflammatory foci in the central nervous system occur

as a sequel, in thirty or forty cases of his own of

multiple sclerosis there could only be found an occasionalone in which there seemed to be some possible connexionbetween a preceding infectious disease and the conditionreferred to. Indeed, in his last twenty-four cases, in no asingle one could any such relation be traced. And so it

is also with reference to the toxic origin suggested byOppenheim and others. No doubt where the patients aredwellers in towns and work in metals, &c., the incidence ofthe disease may suggest some such connexion. But in placessuch as Erlangen, in which the patients are for the mostpart peasants or country dwellers, such a view fails to findany support. Nor can the vascular origin of the scleroticfoci be regarded as likely. It is generally conceded thatmultiple sclerosis has no connexion with syphillis, and it is

not easy to understand why certain small vessels in the

nervous system only should become diseased in some unknownmanner, while similar vessels elsewhere are unaffected. Pro-fessor Striimpell’s suggestion is that multiple sclerosis may

depend upon some congenital abnormalities in the nervoussystem. This view was suggested to him recently by a casewhich he published and in which there were combined amarked condition of hydromyelia, central gliosis, and multiplesclerosis. He had previously observed a case of hydro-myelia with multiple sclerotic foci. Further points in sup-port of such a view are that it is a disease of early life(the first symptoms can often be actually traced backto childhood) and that the axis cylinders are so longspared. It is further suggested that the change may occurfirst in the neuroglia and that there are foci where it under-goes proliferation-a condition, indeed, of multiple gliosis-whose origin is to be sought in some congenital peculiarity.Professor Striimpell, in concluding his paper, directsattention to two conditions in the symptomatology of thedisease. First, as to the character of the disordered move-ment, he believes it does not essentially differ from the

ataxy of tabes, and, secondly, he finds that the abdominalreflex is very frequently absent. This view as to the etiologyof multiple sclerosis is extremely interesting. There are few

objections of much weight to be offered to it, but, of course,it can only be confirmed or refuted after careful and pro-longed examination of many cases in various ways.

THE FOURTH ESTATE AS PHYSICIAN.

A CORRESPONDENT sends us the following, which hereceived from a patient. We omit the date of the month,otherwise we print it as it stands. ----

......... 1894.OFFICES OF TEE " PEOPLE,"

JIILFORD LANE,STRAND, W.C.

Sir,Hererzith we enclose a prescription, take the medicine as

ordered for 2 weeks, if not then better and you n;ould wish tosee a Consultant. we recommend you to arrange an interview

through the Editor.When again applying to the Medical Editor or Consultant,

please enclose your case and a stamped directed e-revelope forreply.We recommend at least one personal interview in all cases where

possible.Readers have the privilege of seeing Consultants and Specialists for

a small fee by appointment.

We should be glad to know who are the consultants andspecialists who can be seen for a small fee by appointment,and whether these gentlemen think it consistent with thedignity of their profession to make a practice upon theselines. Also, who is the gentlemen who prescribes for patientswithout apparently having seen them ? Newspaper prescrib-ing is far too common, and we must congratulate our con-temporary, the Tl,’ee7zly Sun, upon having given up the

practice. -

LEUCOCYTOSIS AND IMMUNITY.

IN the Medical News (New York) of October 17th appearsa paper by Dr. W. A. Wells of Washington on " Leucocytosisand Immunity, with a Critical Analysis of the Theory ofNuclein-therapy." Dr. Wells criticises the views of the

chief observers who have written on this subject and commentsparticularly upon the importance of the presence of

eosinophilic corpuscles, as he believes that there are goodreasons for looking upon these bodies as being very differentand distinct from all the other white blood-corpuscles, notsimply on account of their histological character, but also

because of their different origin and different function. Dr.

Wells summarises his conclusions as follows. 1. Notwith-

standing the long. continued conflict as to the importance of thecell and of the lymph respectively as the protecting agencyof the body it is probable the claims on each side will befound reconcileable. 2. There is no reason for regarding theleucocytosis which appears after the introduction of nuclein