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THE PRIZE SYSTEM.To the Editor of THE LANCET.

SIR,—Permit me to make a few remarks respecting the prizesystem adopted at many of our medical schools at this time ofthe year. I think you will agree with me that the present sys-tem of awarding prizes is altogether wrong. It is a well-knownfact that when more than two students contest for the medal andcertificate usually offered for competition, that the medal only!

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is awarded, but when two try, both are given. I have a friend- who lately competed for one of the prizes with two others, andonly a medal was received. Besides, Mr. Editor, they are notgiven to practical men, but to those who give some authorverbatim. Now, Sir, you are quite aware that it is impossiblefor any man to carry out the treatment laid down for everyparticular case, complicated, as they so frequently are, withother diseases. What is the use of your bookman by the bed-side of a sick person? It is impossible for him to find out thetrue nature of the case ; he finds some symptoms which agreewith one, and others which accompany some other disease,so that he becomes quite bewildered as to what shall be histreatment and what course the disease will pursue. I will, inconclusion, say that the man who is found constantly by thebedside of the sick would gain more knowledge in one weekthan the man who is constantly reading over voluminousbooks in a month, without practice. By finding a place forthe above in your forthcoming number, you will obligeMay, 1854. RES FACTA.

THE CHOLERAIN

THE UNITED KINGDOM IN 1854.

THE concluding paragraph of our article on the cholera,(22nd ult., p. 461,) embodying the opinion of the eminent Dr.Rush, of Philadelphia, to the effect that the means of prevent-ing pestilential fevers " are as much under the power of humanreason and industry, as the means of preventing the evils oflightning and common fire" may be regarded as involving theadmission of a particular point in pathology, the truth of whichis yet believed by others to require satisfactory proof. It iswith some anxiety that we allude to the question before us,since it is of the utmost consequence just now that thepractical results necessarily flowing from such views as thoseof Dr. Rush be pushed to the greatest extreme ; and it mayappear, though only, it is true, from a very superficial view ofthe question, as if our own opinions were rather depreciatorythan otherwise of the laudable endeavour to annihilate " thesources of malignant fevers" and other pestilential affections.But the truth is, that whatever difference might exist uponthe point of pathology, none would prevail upon that of mostinterest to the public-viz., the necessity of having recourse tothe most complete theory of hygiene or preventive therapeiaas practically carried out in an effective system of sanitarypolice. Pathologically, however, difference exists, and whichwe may thus illustrate :-Speaking in general terms, it maybe affirmed that wherever the more marked and more noxiouselements of what has been aptly termed the Great Town

System prevail, there do we usually find the character andravages of epidemics and pestilential affections to be malignantand widely spread. What those elements are we need notdwell upon minutely; but suffice it to say that, in connexionwith foul air, and defective general and local ventilation, the con-tiguity of filth and of decomposing organic and effete remains,with defective sewerage, the burial of the dead in close

proximity to the living, personal uncleanliness, noxiousnessof trade, the consumption of polluted water and of unwhole-some and adulterated food, together with a debased morale,we find the mortality from the zymotic class of (and someother) diseases to be much greater than without them. Thatsome close, indeed most intimate, relation exists betweenthese affections and the noxious elements above named, no onedoubts; nor that, by a careful removal of the latter, we maydiminish very considerably the mortality which at presentexists within the sphere of their operations. But admittingthat something far different than mere coincidence of occur-rence in time and place between these two important factorsexists, what, it may be asked, is the exact nature of this con-nexion and the true expression of its relation in causation and

effect. Now the axiom of Dr. Rush may be adduced to showthat, on the one hand, such "noxious elements" must be held tobe exciting causes of the diseases under review; whilst, on theother hand, it may be affirmed that they are merely predis-posing causes of them.

In the one case, certain anti-hygienic elements being conceded,zymotic pestilences are produced; whilst in the other theirutmost virulence and concentration cannot effect this produc-tion, minus the specific poisons of the special affections. Accord-ing to the first view, the "noxious elements" are regarded as thesource of the zymotic poisons; according to the second, it isaffirmed that " it is a step backwards, not forwards, in patho-logy, to revert to the putrefaction of organic atoms propagated.to the living animal body’ as a principle which explains or com-prehends within itself any of the most material of the phenomenaof febrile diseases ;"* and that " the complete extermination ofsuch diseases, by the annihilation of the causes from which theyoriginally spring, may or may not be within the reach ofmedicine; but it will need a far larger amount of evidence thanwe at present possess, or are likely soon to attain, to enable usto determine, with anything like certainty, what these causesare, and what is man’s power over them. "’I’ Of course we hereexpress the difference of opinion in general terms only, for, asan eminent writer (Dr. Alison) remarks, several, probably all,forms of continued fever may have, even at this day, sepcaa-atemodes of origin. Several cogent arguments might be broughtforward by either party against the opposite doctrine, and ourown judgment we at present prefer keeping in abeyance,until further information shall arise. However, we incline tothe belief that the " noxious elements" spoken of are ratherthe predisposing than the exciting causes of pestilencesand epidemics. We admit the one is just as essential as

the other to the production of the resultant disease, as is wellshown by Dr. Carpenter in his " Predisposing Causes ofEpidemics;" also, that there is an apparent weakness inthe theory we would incline to, if the admission of oneof its most illustrious supporters be necessary — viz., thatcertain specific and zymotic poisons may be " occasionallygenerated under the influence especially of the causes knownto give predisposition to the disease," as this would go far toadmit the essential point in the argument of the oppositeDartv.But if we cannot as yet see our way clear in admitting the

anti-hygienic conditions before mentioned, to be the genesis ofthe specific poisons of the diseases above referred to, we ofcourse admit to the fullest extent their potency in acting asgreat vital depressants, and rapidly and surely predisposingthe organism to yield to the influence of the zymotic poison-germ, when coming within the focus of the latter. But we notonly necessitate the immediate removal of the noxious elementsof the great town system as a main power in mitigating theeffects of epidemic pestilences and of many febrile affections,but go even a step in preventive therapeia beyond thosewho see the origin of the specific poisons in the noxiouselements in question; for we, in addition to those means which.improve the general health, and render the body less susceptible,lay very great stress upon the separation of the sick-, and thosewho have had much to do 2cith them, from those who are personsas yet unaffected. This, in our estimation, most vital considera-tion is te a great measure generally, sometimes entirely, ignoredby those who reject the idea of the particular malady beingspread riia infectione, and as dependent for its origin externalto the human body.The epidemic is now disappearing from Leeds. During the

past week there have been only four cases and two deaths.Diarrhoea is also on the decrease, and it is gratifying to addthat there has not been a single death for eight or nine days.We regret to state that it has returned to Edinburgh,

after an absence of some months. Four undoubted cases

have been reported to the parochial authorities during theweek, and, what is rather remarkable, three of them haveoccurred in the same tenement in which cholera first madeits appearance in 1832. The pestilence still lingers in Glasgow,and has broken out with great virulence in Hamilton andLiverpool.The physicians of St. John’s Hospital, Limerick, have trans-

mitted the following brief report of the cholera hospital in thepresent year, and in the year 184:9:—1854: Total admittedfrom the opening of the hospital to April 27th, 410; dischargedcured, 169; deaths, 241. 1549: Of an equal number of cases--viz., 410-there were cured, 150; deaths, 260. The cases atpresent in hospital, and convalescent, will, at the winding up,

, increase the majority of cures in favour of the present year.* British and Foreign Medico-Chirurgieal Review, No. xxvi. p. 327.

. t Op. cit. vol. xi, p. 160.