ET PEPSIN CO.

(OPPENHEIMER'S.)

This elegant preparation is a combination of Euonymin (from which, by an improved process, all the medicinal virtues are extracted and rendered soluble) with pure Pepsina Porci in a fluid and concentrated state.

The specific stimulating and cholagogue action of Euonymin on the biliary organs, in conjunction with pure pepsine, has proved Liq. Euonymin et Pepsin Co. to be of great advantage in cases of irritative dyspepsia, with atony of gastric or intestinal muscular layers, and especially in relieving pain accompanying gastric carcinoma, pyrosis, and in dyspepsia with water-brash.

66

DOSE: ONE DRACHM IN WATER.

From the British Medical Journal," Feb. 14th, 1885. "An exceedingly valuable preparation, combining, in a very useful and palatable form, a valuable hepatic and digestive agent. It meets a want felt by prescribers in the treatment of indigestion and flatulence due to deficient secretion of bile, as well as atony of the stomach and insufficient secretion of gastric juice. In practice we found it very convenient and valuable."

F. J. B. Quinlan, M.D., L.R.C.S.I., F.K.Q.C.P., M.R.I.A., etc., etc., Professor of Materia Medica and Therapeutics, Catholic University Medical College; and Examiner in Materia Medica and Therapeutics, Royal University, writes in the "Medical Press," July 15th, 1885.

"Every practical physician is familiar with the efficacy of Euonymin as a hepatic stimulant, and Pepsin has passed into the list of therapeutical requisites. Messrs Oppenheimer Bros. & Co., of London, furnish an excellent Liquor Euonymin and Pepsine, which appears to combine very well the properties of both remedies. I have tried it (in doses of a teaspoonful at every meal) in several cases of atonic dyspepsia with torpidity of the liver, and with the best results. Tried by the egg albumen process, a drachm of the liquor at 130° Fahr. effectually peptonises gr. 72, 3 of egg albumen previously triturated through the standard gauze. This is a result of the most satisfactory kind, and one which none but the very best pig Pepsins will equal."

Prepared only by

OPPENHEIMER BROS. & CO.,

Manufacturing Chemists,

1 and 3 SUN STREET, FINSBURY SQUARE, LONDON, E.C.

Price 10s. 6d. per pound, packed (for Dispensing only) in 8 oz., 16 oz., 32 oz., and 64 oz. Bottles.

385

Part First.

ORIGINAL COMMUNICATIONS.

I-VALEDICTORY ADDRESS TO THE EDINBURGH MEDICOCHIRURGICAL SOCIETY.

By the Retiring President, HENRY DUNCAN LITTLEJOHN, M.D., F.R.C.S. Ed. (Delivered 4th November 1885.)

IN selecting a topic for this valedictory address I naturally fall back on those departments of medicine with which I am most familiar, and in which I have worked during my professional life. I trust, therefore, the members of this Society will bear with me for a short time as I treat on some topics in medical jurisprudence and public health which have specially attracted my attention.

First, As to the teaching of Medical Jurisprudence. It has often struck me with surprise that so few of the many lecturers on this important subject fill the post of surgeon of police, and thereby enable themselves to acquire a practical acquaintance with the many forms of violent death, not to speak of the opportunities afforded by that position of giving evidence in courts of law, and of becoming familiar with medico-legal questions of all kinds. It is not to be wondered at that medical jurisprudence is not regarded with interest by the student while preparing to undergo his final trials, and that when he settles down in practice he, as a rule, eschews all cases which may necessitate his appearance in the witness-box. This indifference on the part of the student and practitioner helps to account for the general unsatisfactory nature of medical testimony on trials, and for the continuance of that distrust by the legal profession of medical opinion in a court of law.

The present system of teaching is, in my opinion, fundamentally wrong. The lecturer should be practically conversant with the subject matter of his lectures, and his prelections, instead of consisting of a digest of some of the more popular text-books, should be based on his experience, and, in addition, the student should be brought face to face with the facts of the science in the presence of his teacher, who ought to have the opportunity of demonstrating

EDIN BURGH MED. JOURN., VOL. XXXI.—NO. VII.

4 G

them on the dead or living body. It is only thus that an intelligent interest can be excited in the student, who is thus led to study the subject with practical zest. Facts, the knowledge of which he previously acquired in the course of his reading, now assume an importance and a definition which fix them on his memory in a manner which mere reading can never do. And what is generally regarded by the student as one of the most unsatisfactory subjects of his medical studies becomes at once full of interest, and the lecture-room, instead of being a species of dreary prison-house, is converted into a place where the intelligent student feels he is truly gaining knowledge, and that of a kind which is certain to be of use to him in all departments of his profession.

Where such a method of practical instruction is not available, the student for his examinations has to trust to his notes or to some text-book. Such a method of cramming accounts for the unsatisfactory nature of the examinations on this important subject of medical study. There is nothing more disheartening for an examiner than to have to question a candidate, for example, on the subject of Drowning, and to find that he has never had an opportunity afforded him of seeing a body which has been recovered from the water, and of having pointed out to him by his teacher the various changes incident to immersion in water. It is like examining a student on "Delivery of the Pregnant Female" who has never attended a case of confinement, and who trusts merely to his lecture-notes to enable him to answer the questions of his examiners. How useless it would be to question a student on the subject of Chest Disease who had never walked the wards of a hospital, and watched cases for himself under the eye of his teacher!

What I complain of is that, while due care has been taken to supply the other subjects of medical study with their practical departments, so to speak, no endeavour has been made by the Medical Council and the various licensing bodies to insist that medical jurisprudence should be similarly treated. Thus anatomy has its dissecting rooms; chemistry, physiology, and pathology their laboratories; medicine and surgery and obstetrics, fully equipped hospitals and dispensaries-in all of which the student obtains practical instruction.

Unfortunately, owing to this want and other causes, medical jurisprudence in all our schools is comparatively neglected. Take any of the provincial or even metropolitan schools-medical jurisprudence is regarded with such indifference that it is generally selected as the subject supposed to be most easily taught, and it is usually assigned to the youngest and least experienced member of the teaching staff, although, as you all know, the subject matter of his lectures is drawn from every department of medical study. A case of poisoning, for example, can only be fully investigated by means of very varied knowledge. The symptoms must be contrasted

with those of some disease suddenly established, constituting what is called the "differential diagnosis," by which the medical attendant, in circumstances of great difficulty, is enabled not only to refer the symptoms to some one class of poisons, but even possibly to one special poison, thereby enabling him to select at once the appropriate antidote, and thus save life. Should he be unsuccessful in this, and a post-mortem examination is ordered, he must be able to recognise and describe the appearances in the dead body with the skill of a pathologist; and, lastly, he must aid the authorities in the further investigation of the case by removing those organs and fluids in which the chemist may most readily find traces of the poison.

Our universities are not much better off. With one or two brilliant exceptions, the occupants of the chairs of Forensic Medicine are never called upon to give evidence in a court of law or to conduct medico-legal inquiries. They have no opportunity of bringing under the notice of their classes those cases of sudden death, suicide, etc., etc., which, as you will observe, are of too common occurrence in all our towns. The nature of their prelections can easily be imagined, and with this, which I hold to be, imperfect knowledge, the student passes his final trials and enters on practice. The very first case which comes under his notice may demand from him some medico-legal knowledge and acquaintance with official forms with which he is totally unacquainted. The authorities are put to much inconvenience in consequence of this ignorance; and, in my experience, the facts of the case have too often been so imperfectly noted and reported that the ends of justice have been frustrated.

Now, the remedy I would suggest is this, that medical jurisprudence should be practically and intelligently taught, and this I hold can only be done by the lecturer having some official relation to our criminal authorities. In all our medical schools endeavours should be made to combine the teaching of the subject with the duties of such an office as the surgeoncy of police. It is the official who occupies that position that is summoned to see all cases demanding the cognizance of the police; and as he is generally the adviser of the criminal authorities, he is naturally called upon to make dissections and to conduct inquiries of all kinds relating to the subject-matter of his course of lectures; and he is thus, as I have said, enabled to preserve that practical tone in his prelections which is, in my opinion, absolutely necessary to give them. any authority, and at the same time (a matter of some moment) to interest his jaded auditory; for we must remember that the medical student of to-day is over-lectured, and unless we can appeal practically to more senses than the ear, our tuition becomes comparatively valueless.

When I turn, Secondly, to Medico-legal Practice, I approach a delicate topic, involving the relations between the criminal autho

rities and the profession. And yet I hold that, if we follow the guiding of the "Golden Rule," it is impossible that these relations can ever lead to misunderstanding and breaches of medical etiquette. The authorities have an undoubted right to avail themselves of the best skill and the most mature experience they can command. But the medical man selected ought to remember that in discharging the special duty to which he has been summoned, he has also a professional duty to discharge. Nothing can be more galling for a practitioner than to find himself and his evidence disregarded in the investigation of an important criminal case, when he is conscious that he was the first summoned, and that thus he had the opportunity of observing facts of great importance. The ready answer of the public prosecutor is that he alone is responsible to the Crown for the proper investigation of crime, and that in the exercise of this responsibility he is bound, with a due regard to the public interest, to summon to his aid the best skill of the town or country. This is so far true; but as two medical men are required in an important case in our courts of law, I hold that it is essential that one of these should be the medical man who was first summoned, and who, in all probability, has been put to much inconvenience by being called by the police or the neighbours from other duties, and at an untimeous hour. But let the action of the authorities be what it may, as it is often difficult to get a layman, be he a lawyer or not, to sympathize with the unwritten law of medical etiquette, the duty of medical inspectors is plain,-it is at least courteously to afford the medical man who first saw the case an opportunity of being present at the dissection, and thereby to recognise his position and to lessen his mortification at being overlooked by the authorities. A circumstance has comparatively recently occurred which renders the caution I have just stated of increased importance.

It was for a long period made the subject of repeated complaint, that while in England the medical practitioner was paid the usual honorarium for the dissection, and also for his subsequent evidence at the inquest, in Scotland only one fee was paid for the dissection and for the written medical report, which is the equivalent to the vivâ voce testimony at the English inquest. Lord Advocate Watson, now Lord Watson, has the merit of recognising this discrepancy, and of influencing the Government of the day to raise the fee of a dissection and a medical report from £1, 1s. to £2, 2s. This was a tardy act of justice, but unfortunately it has been clogged with certain formalities which have prevented it being the boon it was expected to be to our profession. Every such increased fee must be made the subject of a separate account, which is made out by the local procurator-fiscal, sent to the Crown office, and there receives the official signature of the Lord Advocate or Solicitor-General. All this involves trouble to a set of already hard-worked, and in many cases underpaid, highly responsible