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cativeness of the worthy functionary in thechair, and a short dialogue ensues betweenthe two worshipful authorities. " How doesthis gentlemau get on ?" replies the expecto.rator. ″ Pretty well," said the examiner,"but he lacks practical Knowledge.’’—″ Oh !

’’

says the asthmatic gentleman, repeating theelrort of the diaphragm and intercostals withmuch energy, and again transmitting to thefloor, what rich folks generally put in theirpockets, and poor people cast away ; " Pray,let me put a few questions to the young gentleman.’’

Tell me, Sir, what is the state of the pulsein jaundice ?-.Jaundice arising from whatcause, Sir?

’

Answer my question, Sir ?-(Candidate,timorously) It is a 2ceulc pulse.

Is it a depressed pulse, Sir ?--Yes, Sir.Why so?-Because the patient is very

weak, Sir.No, Sir ; it is because the proper quantity

of carbon is not removed from the system.I’ray when would you give opium in abdo-minal diseases ?-After bleeding, Sir.

(Examiner No. 2, to examiner No. 1.)Well he has some idea of his profession.Have you tried him on his drugs ?—No.Will you do so ?

(A drawer of drugs is introduced, and ex-aminer points his finger in succession to dif-ferent specimens.)What is this, Sir ?-Cinchona cordifolia.That ?—Oblongifolia.And that ?-Lancifolia.Where do they come from !-Peru, Sir.Which bark contains cinchonia ?-The

lancifolia, Sir.Which contains quina ?-Cordifolia.Which contains both’?-The cinchona ob-

longifolia. -

What is the relative strength of quina andpowdered bark ?-Two scruples of the barkto a grain of quinine.What are the medicinal properties of the

barks ?-They are tonic and febrifuge.Well, Sir, what else ?-Antiseptic, Sir.There is some other property which you

ought to know.—I do not know any other,Sir, unless you mean a stimulant property.No, Sir, I do not. Are they anti-periodic ?

- Yes, Sir.You ought to have known that. In what

cases would you give bark ?-In intermittent fevers.How many kinds are there?-Three; the

quotidian, the tertian, and the quartan.In which is quina least efficacious ?—The

quartan.Why, Sir ?—Because of the number of its

complications.What is the most common complication of

the qaartan form, Sir ?-Enlargement of thespleen. ’

What is that commonly called ?—Aguecake.When would you give bark in intermit-

tents?- When I had subdued all inflamma.tory tendency.’ (One examiner to the other.) Well, Sir,are you satisfied with this gentleman?-Oh,certainly. .

(First examiner to the candidate.) Youmay retire, Sir; I shall recommend you tothe court.The candidate modestly takes his leave,

moving off slowly until the outside of theroom is reached, and then rushing into the funking room" with the triumphant voci-feration of ″ All’s right, by G—. If I hadgot any diseases to describe, I should havebeen nummuxed, but they just gave me theanatomy that I knew. D-n me, old boy"(turning to some friend), ″ you’re all right.Just humbug the old fellows, and you’llpass, depend on’t. What you don’t know,they’ll tell you. Never funk. Hurrah !"

REFORMS IN THE HOSPITALS.

To the Editor of THE LANCET.SIR :—On talcing a retrospect of the im-

provements which have occurred at theLondon hospitals during the last ten years,I must admit that much has been accom-plished by your valuable Journal; indeed,the profession have to thank THE LANCETfor nine-tenths of the reform that has takenplace in them ; and more especially for dis-seminating throughout Europe an immensemass of valuable information, heretofore lostto the community. It may, perhaps, be inte-resting to your readers to notice brieflysome of the beneficial changes which havetaken place during the period alluded to, andafterwards to point out the many abuseswhich still exist.The principal improvements, then, which

have occurred are :-1st. The introduction of clinical lectures,

a department of instruction which was be-fore shamefully neglected in this country,and is even yet but imperfectly taught.

2nd. The publishing of hospital reports,a measure forced upon the medical o1TIcersby THE LANCET.

3rd. The annual distribution of prizes tothe students (which did not become generaluntil after 1826).

4th. The withholding of certificates unlessa few lectures have been attended ; for I re-member the time when it was not an uncom-mon occurrence to hear a student boast thathe had received his certificate without hav-ing attended a single lecture.

Lastly, 1 may mention the posting of no-tices of post-mortem examinations ; theabsence of hole and corner operations; theopening of the libraries and museums ; theestablishment of clinical clerkships ; thegreater punctuality in the visits of the

25

medical officers (although, I confess,there ismuch yet to reform in this respect), and thefrequency of periodical examinations bysome of the teachers, may also be added tothe list of benefits on the part of the studentwhich have been reluctantly obtained fromthe ″ Dubs and PurestThe above changes, however, are unim-

portant compared with those which oughtlong since to have been adopted. The pre-sent system of electing medical officers to

our hospitals and dispensaries, I consider tobe a disgrace to the country, and until theelection by "concours" be introduced, wemust remain, in a scientific point of view,inferior to our continental brethren. I maybe told that some of our hospital surgeonsand physicians have contributed largely tothe advancement of medical science ;" but,let me ask, have they done so in proportionto the opportunities afforded them? I replythat for one working bee we have had tendrones, and it is no answer to my questionto tell me that the soil has " sometimes beenfertile," when, if properly cultivated, it

might always have yielded a plentiful har-vest.The next evil which cries loudly for re-

dress is the system of electing dressers,who are selected, not on account of theirsuperior qualifications for the office, but be-cause they are enabled to pay a large fee tothe surgeon; any man who is at all ac-

- quainted with a public hospital, must havewitnessed the frequent injury to the patientin consequence of the inexperience of thesetyros. Now, Sir, if the surgeons wouldabolish the present mercenary system, and,by public examination, select those studentswho are found to be most competent for theoffice, they would confer a great boon uponsuffering humanity, both by ensuring a betterattendance upon the sick, and by exciting alaudable emulation amongst the youngermembers of our profession.The absence of a resident operating sur-

geon at the hospital is, I believe, anothercause of the annual sacrifice of life. The

following is not an imaginary case, and onenot ofunfrequent occurrence :-A poor manis taken to the hospital labouring under

strangulated hernia, or some other danger-ous disease, and, after being subjected tothe tender touch of a host of dressers, amessenger is sent of! to Mr. -, who re-sides three or four miles from the hospital,and who, perhaps, at the time, is at a greaterdistance from his own residence ; so thatsome hours are lost before his arrival, andsometimes the patient also is lost in conse-quence of the delay.

1 might enumerate many other abuseswhich demand correction, but they havebeen so often noticed in your pages, that Ineed not repeat them. They are, however,I conceive, all dependant upon the presentsystem of medical misgovernment, and will

continue to exist until we obtain electionsby « Concours " and a TRIPARTITE FACULTYO! MEDICINE. This once accomplished, thesystem of nepotism anù jobbing at our publichospitals will necessarily cease; and weshall not then see men who (to use the lau-guage of Dr. South) ″ would have donetheir country greater service at the plough’stail," filling situations requiring assiduityand talent. Your obedient servant,

Sept. 14, 1837. SPECTATOR.

DR. JOHNSON’S REPLY TO DR.DICKSON.

JAMES JOHNSON.

To the Editon of THE LANCET.

SIR:—Having given place to Dr. Dick-son’s long and abusive article, I claimyour indulgence for the insertion of a veryshort reply. He says he is in a conditionto prove, that I not only « take, but demand,’’fees from medical practitioners. I darehim to the proof. I never demanded a feefrom any human being in my life, and Ihave invariably refused fees from medicalpractitioners, when I knew them to be medi-cal. I have ascertained that a few medicalmen, who were utter strangers to me, haveconsulted me without letting me know theiravocation, probably from some erroneousimpression that a more candid opinionwould be given to them. This is surely nosubject of accusation against me. Thereare hundreds, or rather thousands, of prac-titioners in this country, the colonies, andAmerica, who could, and I think many ofthem will, contradict this slanderous asper-sion of Dr. Dickson.

In respect to servants, I certainly do notproclaim gratuitous advice to them, in orderto catch stray fees from their masters. It ispossible, that a fashionable lady’s maid,who has caught tlae airs as well as thevapours of her mistress, may occasionallyfee me for my advice, without my beingable to discriminate her rank in life; but,without making any parade of my liberality,it is just possible that I am as little inclinedto wring money from the hands of the pooras my accuser.

Dr. Dickson’s rabid ravings against pa-thology, the lancet, and the stethoscope,prove him to be inattentive to, if not igno-rant of, some of the most important meanswe possess of improving our profession.As to his theory, if it ceserve such a name,its only redeeming quality is its matchlessabsurdity, which, in despite of its intole-rance and bigotry, must convulse everyreader with laughter at the brain thatcould engender such a chaos of crudities,such a perversion of reasoning, and such a

labyrinth of errors. I am, Sir, your obe-dient servant, JAMES JOHNSON.

Sept. 25, 1837.