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under very disadvantageous circumstances-when weariedin the evening, for instance, or at odd hours amid the dis-tractions of practice; and, further, that he usually wrote bydictation, and employed as his amanuenses his artist, Mr.Bell, who was uneducated, and sometimes even his coach-man. Further, too, it must be borne in mind that severalof his publications did not receive his final corrections, butwere published with but careless revision after his death.His obscurity is also to some extent due to the fact that hewas dealing with thoughts which went deep, and for whichas yet there was no familiar vocabulary. To these facts, aswell as to his defective education, we must attribute thecircumstance that he but too often permits himself the useof vague and metaphorical expressions.Hunter, although speaking with strong disparagement of

the definitions, saying of them, "That of all things on theface of the earth they are the most cursed," could not helprecognising that they are essential to exactitude of thoughtand clearness of description. He is, therefore, constantlyattempting them, and with that candour of mind which isone of his characteristics, as constantly admitting the inade-quacy of his efforts. Thus he ingeniously defines the wordpoison so as to exclude arsenic on the one hand, and the small-pox virus on the other, and he calls the reader’s attentionto the fact that it does so. His definition of a "morbidanimal poison" takes in cancer and the itch. Respectingthe latter, and its supposed association with an animalculewhich could be seen by the microscope, he suggests " thatparticles of matter may have been floating in the poisonwhich a lively imagination might suppose to be animalcule;"and adds, " but that these animalcula are necessary to theexistence of the disease I totally deny."1 Definitions,indeed, appear to have exercised a sort of fascination over ’Hunter’s mind. He is much puzzled by the difficulty of sodefining the terms " shrub "and "tree," as to distinguish ’,the things. Throughout his most interesting essay onGeology he is plagued by doubts as to the legitimate useof the word " fossil ;" and for the first and only time, sofar as I have noticed, he betrays some anxiety as to whatthe critics may say.

If, however, from internal evidence, we may venture tocontend that it is certain that Hunter’s education in boy-hood was far from neglected, what shall we say as to the im-portant years which elapsed between school and the com-mencement of his London career at the age of twenty-one ? IWe know that, some years later still, when his brother ’entered him at Cambridge with a hope of repairing the Ifhalf-wasted opportunities of youth, Hunter himself peremp- ,,

torily put an end to the plan, and declined "to stuff Latinand Greek." That he was in the right then few will doubt, !,for he was advancing in years, and his tastes for anatomyand zoology were in full force. It would have been a mistakethen to fall back upon the classics. This does not, however, byany means prove that University training at the proper timewould not have been very useful to him. We know whatHunter, unaided by this training, did actually accomplish;but we shall err, I think, very seriously if we conclude thathe would probably not have accomplished so much had hisyouth been spent at a University instead of in a cabinet-maker’s shop. The subject is too large a one for discussionhere, but we may remember that the possession of classicalknowledge did not encumber the minds of Bacon, of Harvey,or of Newton. I will ask your permission to record myown conviction that, had Hunter obtained it at the propertime, it would have been greatly to the advantage both ofhis readers and himself.

For those of us who are placed in positions of responsi-bility as regards the future training of the medical professionimportant lessons are to be obtained from Hunter’s life.

’ In the first place, let us impress ourselves with faith in thepower of that innate desire for knowledge which is theinheritance, if not of all, at any rate of all in the leastfitted for our pursuits. We have seen what it effected inHunter’s case. Hunter was not alone in its possession."Who loves not knowledge?" " It is not that its posses-sion is not a delight to all, but that the toilsome methodsby which it is acquired, and the difficulty with which it isretained, disgust the idle and sometimes dismay even thezealous. Let us adopt Hunter’s methods, and take ourstudents more directly to Nature herself. Let our educationbecome more objective, and concern things rather thanbooks. Let us renounce utterly all remnants of the methods

1 From Parkinson’s Reminiscences, p. 157.

by which the pedagogues of the past so often succeeded immaking the very name of education distasteful. Let us.trust to the intrinsic attractions of our subjects, and resortas little as possible to compulsion in respect to methods ofstudy. Let our examinations become more objective and*less merely verbal, and the examiner will soon be recognisedas the friend and not the torturer of the candidate. Aboveall, let us avoid the error of trying to make all minds fit into-one and the same mould, and, whilst doing all we can to,encourage breadth in preliminary study, let us rememberthat there have, from time to time, arisen men who without.its aid have brought gain to Science and credit to them-selves and their profession. Lastly, in reference to our

University schemes and curricula of education, let us.

remember Hunter’s aphorism, that life precedes and causesorganisation, not organisation life; and beware lest by the.premature imposition of a too artfully contrived organisa-tion we hinder the development of life.

ABSTRACT OF

The Milroy Lectures,ON

DIPHTHERIA, ITS NATURE, HISTORY, ANDPREVENTION.

Delivered before the Royal College of Physicians ofLondon,

BY R. THORNE THORNE, M B., F.R.S., F.R.C.P.

LECTURE I.

DR. TnORNE THORNE commenced these lectures byrecalling the labours of Bretonneau, and his desire to-attach a specific name to a specific phlegm asia which shouldbe anatomically distinct, as also Hirsch’s criticism, that the-identity or otherwise of two or more diseases in a group-could only be determined by having regard to their ana-

tomical, clinical, and, above all, their etiological aspects.He then referred, first, to the failure from the anato-mical point of view to differentiate between the severalmembranous affections of the throat, next to clinical medi-cine as not supplying the means of distinguishing betweenthe infective or the benign character of throat diseases; andwhilst dawning that great advances had in recent years’been made as to the etiology of the disease, he admittedthat in this respect, too, we had many of the former diffi-culties still to deal with. It was next shown by referenceto statistics that during the last decennium there had beena substantial increase of diphtheria mortality in this country,and that a very significant portion of this increase had takemplace in the metropolis. This increase was the more remark-able because whilst it had been in progress the zymoticgroup of diseases, and notably those causes of death which,are amenable to sanitary administration and public healthmeasures, had undergone steady diminution. He next referred in some detail to the statistical researches of Dr.G. B. Longstaff, and to his comparisons of the relativediphtheria mortalities in districts that are divided into-dense, medium, or sparse according to the density of theirpopulations, and from these statistics it was shown thatwhereas antecedent to 1860 the diphtheria rate for the sparsedistricts was double that for the dense districts, the rates.during the period 1871-80 for these respective districts hadcome to be nearly equal. In short, the incidence of diph-theria was undergoing a change, and the preference whichit had formerly shown for rural areas was being transferredto dense communities. Indeed, the increasing excess whichhe had referred to in the case of London was found to extendto the large towns and cities as a whole; these urban districtshaving in 1889 a diphtheria mortality of 0’26 per 100(as opposed to one of only about one-half-namely, 0’14—ia1881. The circumstances detailed were, it was alleged, suchas to call for a searching inquiry into the natural historyof the disease, especially as regards its causation andprevention.Turning next to the historical aspect of diphtheria, it was

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shown that a disease indistinguishable from it, and this evenas regards its paralytic sequelro, was known before theChristian era, and as to this country the quaint writings ofNoah Webster were quoted in which comets, meteors, andother phenomena were conjured up to account for epidemicsof throat disease other than acarlatina,, which vividly re-

called the several features of diphtheria prevalences in ourown day. The first recognised prevalence of diphtheria inEngland, alleged to have been imported from Boulogne, wasdiscussed in connexion with the writings of Simon, Green-how, and Bardon Sanderson ; and then the general distri-bution of the disease in different parts of England andWales was considered in some detail by the aid, in theanain, of Dr. Longstaff’s statistics. The broad geologicalfeatures of the country were shown to have no direct influ-ence on diphtheria mortality, and as to attacks apart from- death no sufficient data are available. Some areas

in the same geological formations exhibited the most

striking contrasts in this respect; but at the sametime Dr. Thorne differed from other authorities who(had declared that soil, and this even when altitude.and dampness were also in question, had no concern in thedevelopment or diffusion of the disease. The two areas inour own country where diphtheria had caused the highestrates of mortality were shown to lie along our exposedmorth-eastern and eastern coasts, and in the mountainous,districts of Wales, and this especially in the damp valleys!so abundant in some Welsh counties. Clays, as such, were;shown not to have excess of diphtheria death ; indeed, thegreat stretch of the Oolite from the borders of Lincolnshireinto Dorset, where clays abound, was the line of England’sgreatest immunity from diphtheria, a circumstance whichvas largely attributed to the facilities for drainage affordedby the flow of the great rivers which drain that area. Onthe other hand, where water was upheld in clays or in,gravels, and where to the resulting dampness was super-added a cold, bleak air and vegetable decomposition, thereit was held that conditions favourable to diphtheria existed.But at the same time other conditions favourable to the,disease were shown often to outweigh all considerations ofclimate and of soil. These points having been somewhatfully discussed by the aid of charts and diagrams, Dr.Thorne further illustrated them by somewhat detailed re-ferences to epidemics which he and his colleagues at theLocal Government Board and various local health officershad investigated. And as to the influence of soil-wetness,it was suggested that whilst stagnant water, like stagnantair, was conducive of ill-health and probably of diphtheria,the result of moving water, as in the drift along the beds of;great rivers, was probably in no such way injurious.The influence of season was next considered, and it

was shown generally that over a long period of years’excess of diphtheria mortality had occurred during thefourth quarter of the year, a circumstance that had in’some respects been held to favour the view of a fungoidorigin of the disease. Comparison between attacks and,deaths from this disease was not possible in the case ofthe large towns where compulsory notification had beenadopted, and the records as to this, which had been com-piled owing to the initiative of Dr. John Tatham, werereferred to in this connexion, with the result of showing=that a striking rise in diphtheria mortality takes place inthe month ot October, that this hardly abates during:November, but that after this it shows a tendency to,diminish. But with regard to attacks it was evident thatdiphtheria increased at an earlier date, the month ofSeptember showing a marked number of attacks. And, onthe other hand, the January deaths from diphtheria were,in not unimportant amount, due to attacks commencing inDecember. How far these urban statistics could be heldas applicable to rural areas Dr. Thorne did not feel able to,say, but the urban experience was stated to be generally’the same as that observed in prevalences, that had beencarefully investigated in the country, as a whole.Coming next to the question of sex, some of Dr. Thorne’s

experiences were referred to, and this especially where hehad expressed the opinion that the excess of diphtheria in’females over males during the first fifteen years of life wasprobably due to the fact that female children are likely to bebrought into closer contact with the infected sick than isthe case with boys. This bad been generally accepted byDr. Downes as applicable to females who had passed theage of childhood, but the latter observer had broughtforward a number of statistical and other considerations

which he thought tended to show that there was also somephysiological proclivity amongst females to take the in-fection beyond that which attached to males. Dr. Thorne,on the other hand, gave his reasons for believing that ingirlhood, as in early womanhood, there was in femalesopportunity for greater and more sustained exposure toinfection than in males.The question of age incidence as a predisposing cause

was also fully discussed. The greatest proportion of totaldiphtheria deaths was shown to fall on the period three tofifteen years; a still greater incidence was found on theperiod three to twelve years, and a further excess on theperiod two to five years. The comparative scarcity ofdiphtheria mortality was referred as related to such cir-cumstances as avoidance of exposure to infection, the useof breast milk and of milk preparations practically sterilisedin process of manufacture, as possibly also to the rudi-

mentary character of the tonsils at a period of life asso-ciated with the functional obliteration of the thymusgland. But this question of age incidence was found tobe much involved in other considerations. Thus, the agethree to twelve years is essentially the school age, and so-called school influence here comes into operation ; it is theage when diphtheria is a much more recognisable diseasethan at some later ages, and in rightly appreciating howfar question of age may be one merely influencing theclinical features of the local affection, much was held todepend on the right interpretation which ought to be puton the term " diphtheria " as used both in mortality and insickness returns.

ABSTRACT OF THE ORATION OF THE HUN-TERIAN SOCIETY FOR 1891,

ON PSYCHOLOGICAL MEDICINE IN JOHNHUNTER’S TIME AND THE PROGRESS

IT HAS SINCE MADE.Delivered at the London Institution,

BY FLETCHER BEACH, M.B., F.R.C.P.,MEDICAL SUPERINTENDENT, DARENTH ASYLUM ; HONORARY

SECRETARY, MEDICO-PSYCHOLOGICAL ASSOCIATION.

MR. PRESIDENT AND GENTLEMEN,—When you did methe honour to request that I should undertake such an

important duty as the delivery of the Hunterian Oration, Ihad some difficulty at first in deciding upon what subject toaddress you. The life of Hunter has so frequently beendwelt upon by brilliant orators, such as Paget and others,that it is impossible to bring before you any facts that arenot already perfectly well known. On reading an accountof his life, one cannot but be struck with his marvellouspower of work, his untiring energy, and his completedevotion to science in so many departments. Lawrencetruly said that " he was the greatest man in the combinedcharacter of physiologist and surgeon that the whole annalsof medicine can furnish." Physiology, surgery, and theformation of his museum did not take up the whole of histime, for, on looking through the first volume of his " Essaysand Observations," arranged and revised by Sir Richard0 wen, I was surprised to find that he was also a psychologist.Hunter was eminently a practical man, and, had he lived longenough, he would no doubt have applied his psychology to theelucidation of many points in surgery and medicine. Ittherefore occurred to me that the condition of psychologicalmedicine in Hunter’s time and its subsequent progress might.be a profitable subject whereon to discourse to you.

It appears that during the earlier years of Hunter’s lifethe belief that the insane were possessed of the devil hadnot entirely passed away, and ignorance and superstitionguided the treatment. Ducking the lunatic was practisedin some parts of Cornwall, while in Scotland lunacy healingwells and superstition survived as late as 1793. In Ireland

: the most important of the many stories connected with the: treatment of the insane is that concerning the Valley of the

Lunatics, in which are two wells, to which lunatics used toi resort, drink the waters, and eat the cresses growing oní the margin ; the firm belief being that the healing water,I the cresses, and the mysterious virtue of the glen would