dangers are not far away. It is exceedingly easy to travel round and round within a very narrow circle-to become a "routinist” in a bad sense of the word-and that not because there are not plenty of materials within reach, but because it is too much trouble to charge the memory with them and to apply them. This is a downfall to a state of laziness seldom recovered from. The fresh and early years, when a man may be a student in the highest meaning of the word, should be employed in gathering from all quarters the works of the "old masters;" in studying the infinite combinations of remedies, and the various subtle ways by which we may compass a specific end. Is not all this as worthy of consideration as the shape of a splint, the material of a ligature, or the curve of an obstetric forceps? The properties of all the formulæ of opium and its derivatives, and their uses under various circumstances, the splendid efficacy and special dangers of hypodermic morphia; and the emergencies which can be appeased by opium or other narcotics respectively, form in the aggregate a subject deserving of patient thought and elucidation, It was Prometheus who "told the hidden power of herbs and springs, And disease drank and slept." No gold can buy a knowledge of this "hidden power," but more and more of it can be learnt every day by the honest searcher after therapeutic laws. It is vain to sigh now for the ancient days of medical "apprenticeship," but many fruitful seeds were sown in those days; and he was an idle pupil who did not reap many a good thing from the hands of an apt teacher, to pass in time to others the sound traditions of our art. We have not Dr. Paris's "Pharmacologia" by our side, but we well remember the rules and ordinances laid down there for the interior structure of prescriptions. There is to be a regular procession of substances, according to gradation of rank. The most important article ought to be named first, then the article next in power; auxiliary tinctures and syrups come in due file and order; and the aqueous menstruum brings up the rear. What a torture it must be to the ghosts of old classical physicians to see the "directions" written in plain vulgar English, ostensibly to avoid mistakes with the dispenser, but too often in reality to hide the prescriber's ignorance of Latin phrase and Latin idiom. And, oh, behold the countless species of the genus prescription! There is the bald prescription, consisting of a single substance dissolved in water, without any ornament of syrup or tincture. At the other extreme is the rhetorical and 1 Shelley's Prometheus Unbound.' florid prescription, made up of eight or ten articles, most of which are themselves compounded of several others. Between these points comes the prescription of meek and conventional stamp, not rarely the sure index of poor and penurious resource; alas! how often met with here and everywhere. Then there is no more certain sign of equal mind and genuine accomplishments than a prescription of emphasis and nerve, telling its own story of single aim and object. We are grateful to Mr. Beasley for collecting so much lore; but we wish that he had weeded his garden, for the flowers are nearly choked. What benefit is it to know the things prescribed by Wendt, Recamier, Tode, and Foy; their utterances may furnish a curiosity shop, but otherwise they are of little value. If Mr. Beasley had bravely discarded 2000 of his prescriptions, and carefully classified the remaining thousand, the boon he has offered to us would have been more artistic and more truly accessible. We want, says Addison, less of "show and ceremony, and more natural good sense and beauty." The wide interest displayed in every therapeutic discovery is a guarantee for the spread of therapeutic knowledge among all ranks of the profession. When we call to mind the slow and sceptical way in which cod-liver oil was received, we are cheered and encouraged by the history of chloral, and the almost joyful rapture with which it was taken up, as if it filled a broad gap in our defences. The student leaves his school with a more intelligent faith, and better equipped for the exigencies before him. He may have been among the audience of such a course of lectures as Dr. Brunton's on "Experimental Therapeutics;" and though he has caught only the faintest echoes of the lecturer's meaning, he is impressed with the method by which, out of frail dynamic elements, positive knowledge has been gained. Scoffs at the uncertainty of physic are no longer heard from professors' chairs; but learned men pleasantly debate whether Nature is a healer of our troubles by "elimination," or whether she is a cruel "stepmother," destroying more bodies than she saves. Awkward hypotheses about "change of type" in disease are hardly necessary now; the problem is solved by a mere glance at our progress, both in our means of diagnosis and in our enlarged powers of treatment. If any one desires to be acquainted with what has been done in a single subject let him peruse the "Lumleian Lectures" for 1843, delivered by a distinguished living physician; the third lecture is on "Affections of the Brain and Spinal Cord depending on Acute Disease of the Heart."2 In the refinement of our instruments for 1 'Spectator,' 119. 100-L. 2 London Medical Gazette,' May 25, 1843. detecting morbid changes and their pathological relationship with other changes, do we not discover a vera causa for the doctrines of "support" and "rest," instead of starvation and depletion? Pericarditis and endocarditis must be the same now as then, and so must be the disorders which they provoke and resemble. And thus, having boundless faith in the certainties of medicine, the practitioner will give advice to his clients with (as Dr. C. J. B. Williams says) "confidence and clearness," making them willing sharers of his own faith. And though there may be mystery in what we do there is no miracle. The mystery decreases day by day; and we need not exaggerate it by exclaiming, in a sort of ignorant surprise, "The medicine acted like magic;"" the symptoms vanished as if by a charm." "Magic" and "charms" belong to the babyhood of science, and are instinctively rejected by the inductive mind. Modern scepticism invades everything, and its ravages should make us determined to be exact and true. All winds and tides may bring sceptics, but they ought not to be found within our own citadel. We have, however, lately met with two such perverse instances of unbelief in eminent members of the profession that we are compelled to "show them up" for a terror to the world. Dr. T. King Chambers1 thinks that iodide of potassium cannot cure a syphilitic sore-throat; and Dr. Bristowe puts the question whether any one has seen erysipelas subside under the obvious influence of some special drug. After this, we might doubtingly ask ourselves, Did the sun rise this morning? Did we ever see any medicine do any good whatever? Distinctly and unhesitatingly we assert that syphilitic ulcers of the soft palate and tonsils can be cured by iodide of potassium, and by nothing else (save, of course, its chemical congeners, iodide of sodium or of ammonium); and within the circle of therapeutic facts we are hardly aware of any sequence more remarkable than the cure of erysipelas by tincture of perchloride of iron. Now, when we recollect what was thought of erysipelas in Cullen's age; when we read such an elaborate article as that on erysipelas in Costello's inchoate 'Cyclopædia of Surgery'-a splendid monograph for its time (1841)—we ought to be abundantly thankful for the firm check which we have at the present day over one of the most ugly of spreading diseases. Why, then, all this slowness to believe? We desire to hide nothing; we 3 Dr. Russell Reynolds' “ Observations on the Use of Iron in Rheumatism” may lead us to perceive some remote analogies. "Rheumatism" is a genus which will one day be broken up into species, and we shall write and speak of erysipelatous rheumatism, neurotic rheumatism, and malarious rheumatism; perhaps others also. wish to let our foes know our weakest and worst; but, surely, we need not be ashamed of our possessions, gifts held by us in trust for the benefit of all humanity. We close our retrospect with sincere congratulations to our fellow-labourers, and with pleasing hopes for the future. Let another decade produce the same fruit as the last and therapeutics will approach the rank of positive science. Our business is to work on, and to work ever; to help in plucking out the roots and seeds of danger and death which infest the human race, and to plant every man, woman, and child in the conditions most favorable to health and longevity. Pseudo-philosophers may sneer, anti-vaccinators may hinder the "good day coming;" but the confraternity of healers can never be daunted or diminished. The physician's calling, lauded in Holy Writ, sung by poets, celebrated by historians, will ever receive its meed of glory in all times and among all nations : "A wise physician, skill'd our wounds to heal, VIII.-Operation Statistics.' THERE can be no doubt about the value of statistics. It does not require the action of a statistical society, with its large and cogent conclusions, to convince us of this. The statistical method of inquiry is now accepted as one of great use in all departments of research. An appeal is made to the inexorable logic of facts, and an array of statistics is brought forward which seems to settle the question. And yet there is in the public mind a very general distrust of the conclusions which are thus arrived at. It is said that figures may be manipulated so as to make them prove anything that the advocate wishes, and that it is as easy to arrange figures in tables as it is to place the pieces on a chessboard. Certainly there is ground for distrust when we observe what very different conclusions are drawn from the same facts, statistically considered. Indeed, the statistical method is one which is open to many fallacies; yet where these fallacies are carefully avoided, it is 11. Observations et Statistiques pour Servir à l'histoire des Amputations. Par le Dr. L. ROBUCHON. Paris, 1872. P. 74. 2. Clinical Surgical Report for the year 1871. By GEORGE BUCHANAN, A.M., M.D., Surgeon and Lecturer on Clinical Surgery, Glasgow Royal Infirmary. P. 11. 3. Hospital Report for the year 1871. By JAMES MORTON, M.D., Surgeon and Clinical Lecturer, Glasgow Royal Infirmary. P. 16. M as cogent as a demonstration; but to avoid them is no easy matter. When the question that is to be judged by statistics is at all a complex one, the pitfalls become proportionately more numerous, and the danger of falling into them more imminent. Now the questions which surgery proposes to the statistician are, most of them, remarkably complex. Slight variations in the direction of a fracture, or in the extent of a contusion, or, above all, in that subtle thing which we call the constitution of a patient, may make all the difference in the result of the case. Upon such apparently trifling matters may hang the issues of success or non-success, of life or death. Yet these minute variations are beyond our power to estimate. What, for example, do we know about the differences in the natural constitutions of our patients? In old books belonging to the beginning of this century and before that date, it is common to read that the patient was of a sanguine, a bilious, a phlegmatic temperament, and so forth. But these terms convey no very accurate meaning, and we derive no practical advantage from setting down one individual as sanguine, and another as phlegmatic. It is wiser not to catalogue our patients at all, than to attempt to divide them according to peculiarities about which we know little or nothing. To classify the different varieties of natural constitution, to try to determine their respective liability to various forms of disease, and the general rules of treatment applicable to each, would be a work worthy of a great mind, and of the labours of a lifetime. If even an approach could be made to something like certainty upon this subject, it would go far to give precision to our practice and value to our statistical conclusions. It is because things are compared which are not essentially comparable one with another that so much doubt rests upon statistics. And until our knowledge is mnch more advanced than it is, not merely with regard to the varieties of human constitutions, but also upon many other points, it will be impossible for us to arrange cases in such groups as safely to draw minute statistical conclusions from them. Upon some large and elementary questions health statistics are, no doubt, even now of great value, and have done much to impress certain broad general truths upon the public mind. But when we go further than this, when we ask for precise information with regard to the risks of various injuries, or the benefits of certain modes of treatment, we see at once how little guidance we can expect from statistical inquiries in the present state of our knowledge. These conclusions thrust themselves upon us in reading the pamphlets whose titles stand at the head of this article. They are very interesting; some of the cases referred to are rare |