and all the facts connected with the epidemic must be too fresh in our readers' memories to make such recapitulation necessary. *

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"The present epidemic has afforded other instances of the choleraconveying power of water-though, happily, nowhere else has the experiment been made on anything like so gigantic a scale-and the evidence on the same point afforded by former epidemics is well known. As the president of the Epidemiological Society remarked, 'It is now placed beyond question by the labors of Dr. Snow, confirmed as they have been by experience, that water is one of the great agents in diffusing cholera;' or, to quote Dr. Farre once more, unclean water can not be consumed with impunity; its consumption is the sin of which cholera is the punishment.'

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"While sanitary science won such a triumph in its battle with cholera, it can not be said that any marked advance was made in the treatment of the disease. The most diverse and opposite opinions and modes of pr actice were to be heard and seen. Former experience really seemed to avail nothing; old methods of treatment which had been tried in former epidemics and had failed, were again tried, and with a like result; and unless we have learned to remember the teachings of this epidemic as to treatment, longer and more exactly than the lessons of previous ones, we shall have learned very little. Two theories of the pathology and treatment of the disease have been promulgated with special persistence and assurance. One, that of Dr. George Johnson, argued out and supported with great ability and zealousness, is, briefly, that the malady is due to a peculiar poison, which, entering the blood, first and most especially affects the minute pulmonic arteries, causing a state of spasmodic contraction and closure of them, and consequently an arrest of the oxidation of the blood; that the vomiting and purging are natural efforts for the elimination of the poison; and that, therefore, the proper and rational way is to favor and assist this effort of nature. The other, Dr. Chapman's, put forth with equal zeal, attributes the disease to hyperæmia of the spinal cord and the sympathetic system, and treats it by ice applied to the spine. Each theory is based on assumptions rather than on proved facts, and each has been insisted on with equal positiveness and conviction of its truth; but neither can be said to have been at all generally accepted or to have met with any marked success. The general result of treatment is, perhaps, a belief that in the earliest stage of the disease, and in the prodromic diarrhea, astringents and opiates are most to be relied on, with rest and warmth, and, in the stages of collapse and reaction, careful nursing and support.

"The full extent and degree to which the epidemic has prevailed in England is not yet known, as the official information on the subject, conveyed only by the Registrar-General's Quarterly returns, does not at present go beyond the end of September. Up to that time the total number of deaths from cholera registered amounted to 10,365, very nearly half of which had happened in the London districts. The disease prevailed, as usual, in particular districts or 'fields.' The most fatal field after London, was the Liverpool field.' In the northwestern counties of Cheshire and Lancashire, there were 2,022 deaths from cholera; and of these 1,603 were registered in the Liverpool and West Derby districts. The next largest mortality-1,514 deathsoccurred in the Monmouthshire and Wales division,' or the 'Swansea field,' the greatest number of deaths happening in Swansea, Neath and Llanelly. The south, north, and west midland counties almost escaped the disease; and in Herefordshire and Rutlandshire no death from cholera had been registered. The south-eastern counties suffered rather severely. Ramsgate was included by extension down the Thames, in the London cholera field;' and into other parts of Kent the hop-pickers from London imported the disease. The summary of the RegistrarGeneral's analysis of the course the epidemic had taken so far was thus expressed: The epidemic has been most fatal on the sea coast in the chief ports of the kingdom. It is by no means capricious, but obeys definite laws. It never destroys the people to any extent where the water supply is pure, or where the hygienic conditions are good, when the authorities adopt judicious and well-organized measures of early and systematic disinfection.'

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"The International Sanitary Conference of Constantinople for preventing the diffusion of epidemic cholera and for the preservation of Europe from future invasion of the disease has made its report. It considers that the disease originates only in India, never in Europe; that it is a transmissible disease, following in the wake of man, and not carried by the atmosphere to any distance; that it is spread chiefly by the evacuation of cholera patients, and that it rages most in places in a bad sanitary condition; it believes that the cholera poison may adhere to the surface of clothes, the walls of houses, the interior of ships, etc., and that by these means it may be communicated. On these principles it bases its proposed measures of preservation, and asserts that the disease is to be met by measures of restriction of intercourse, of purification and disinfection, and of public and private hygiene. We have nothing to say of the measures of purification and disinfection recom

mended except that they seem to be very full and perfect, and quite practicable; but for the measures of restriction and of hygiene we must remark that, however perfect they may be theoretically and scientifically, many of them appear to be so impracticable as to be useless. For instance, the Conference objects to the system of drains and sewers in communication with houses, and it calls for the abolition of all privies and cess-pools or wells, and their replacement by movable receptacles, such as earth closets, or 'fosses mobile,' to be frequently emptied and cleansed, and so constructed that the contents can not sink into the soil; the contents to be carried out of the towns; water-closets, when used, never to be within the houses. However desirable all this may be theoretically, is it not quite impracticable in cities of any size? while to recommend such a scheme for cities of one, two, or three million inhabitants, appears with all due respect be it said, simply ridiculous. And supposing that all excreta could thus be removed out of the town,' what is to be done with them? where are they to be buried so as not to contaminate the soil? Again, the quarantine measures recommended are such as never can be carried out. They are neither practicable nor rational,' as Dr. Farre said in the discussion which followed Dr. Goodeve's valuable and lucid statement of the results of the Conference at a meeting of the Epidemiological Society. The quarantine recommendations were, we believe, carried in opposition to the advice of the able and experienced English representatives at the Conference, Drs. Goodeve and Dickson; but a full analysis of the Conference will be found in our pages during the month of October.

"The General Medical Council met on May 17, sat eleven days, and got through a considerable amount of speaking and some business. They finally settled a Medical Acts Amendment Bill,' which we may hope to see passed next year, if Reform does not again stop the

"But the acts of the Council, and all that they did, are written in the first volume of our journal for the year, and to that record we must refer the reader, as we really have not the heart to go more into the detail here. We have so much respect for the individual members of the Council, and so little for the results of their collective wisdom, that we will be content to notice thus shortly what they actually did, and to cherish still, as best we may, the hope that they may in time overcome the difficulties inherent in their constitution as a body, and justify more satisfactorily their costly existence, and their liberal expenditure of time and labor.

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"At the Royal College of Physicians, Sir Thomas Watson was again,

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and for the fifth time, unanimously elected President. But in addressing the Fellows, with his usual graceful and happy eloquence, on the occasion, he observed, 'Should I survive the coming year, and-which I have the presumption to suppose to be even more likely-should your kindness toward me also survive it, it will be my duty to make way for some younger and abler (?) President. Five years' occupancy of this chair is, in my opinion, quite as much as is good either for the College or the President himself.' "The trial of Hunter v. Sharpe,' deserves mention here, as, though not directly affecting medical men, it had so much to do with the conduct and honor of the profession, and was of such importance in iefining the legal limits of criticism, that we are all deeply interested in it. It was an action for libel, brought by Dr. Hunter against the Pall Mall Gazette, on account of a very severe and trenchant criticism on that person's pretensions, conduct, and practice as a physician. The courage and downrightness of our able and spirited contemporary. in defense as well as in attack, were most admirable, and the result was that the jury considered the article complained of had so far overstepped legal bounds that they gave Dr. Hunter a verdict, with one farthing damages. The medical evidence adduced for the defense was remarkable for its clearness, ability, and unanimity, and the Chief Justice's summing up, a magnificent display of talent and eloquence; it merits the study of every one for the clear and lucid way in which it points out the differences between the conduct and mode of practice of the quack and the honorable practitioner of medicine. *

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"Some of the London hospitals were visited during the year by a female physician from America, who, not content with private practice, had also served as a surgeon in the Federal army during the late war. Dr. Mary Walker wore a hybrid, or rather a hermaphroditic, kind of dress, which, according to her own description, 'was constructed on physiological principles with moral bearings;' and she gave a public lecture at St. James' Hall, but probably only the enemies of the order of female physicians would call the performance a success. We are not ourselves believers in the need for, or probable success of, a class of woman-doctors, and we are very sure that if ever such an institution is to live, it must be modeled after the modest, feminine, unobtrusive type so favorably shown in Miss Garrett, at present the sole English example, and not after the somewhat aggressive one imaged forth by our trans-Atlantic sister.

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"Among the pleasing events of the year, we were glad to record that Dr. Burrows, on the resignation of his appointments at St. Bartholo

mew's, received a very handsome and gratifying testimonial of affection and esteem from his colleagues and pupils, old and young; that Mr. Henry Thompson had been appointed Surgeon Extraordinary to the King of the Belgians; that Dr. W. Mackenzie, C. B., of the Madras army, has been made a 'Companion of the Most Exalted Order of the Star of India,' and Sir James Clarke made a K. C. B.; that Dr. Markham, as well as Dr. Edward Smith, had been appointed Poor Law Inspectors; and that Drs. J. Y. Simpson, Dominic Corrigan, and Watson, have, like Sir William Fergusson, last year, received the honor of the Baronetcy, the highest dignity ever bestowed by the Crown on members of our profession. All well deserved the distinction, but the recognition of Sir Thomas Watson's eminence gave special satisfaction to the profession at large, as it has seldom been the lot of any physician to command such universal confidence and respect by his intellectual powers, and to win such affectionate regard by his character, as has the popular President of the College of Physicians."

Change of Type in Disease.

Dr. Markham has republished his Gulstonian Lectures on "Bleeding and Change in Type of Diseases," which appeared in this Journal. In the Preface will be found an interesting letter from Sir Thomas Watson, wherein, with his usual candor, he admits that his views touching the change in type theory have undergone modification. Such a statement from so high an authority is worthy of especial attention. We are sure our readers will be glad to see his letter in extenso. The question involved in the change of type theory is not a mere matter of theoretical discussion. The practical fact of bleeding in disease is closely connected with it. It will be seen that Sir Thomas Watson indorses the opinion given by Dr. Markham: that (whatever be the explanation) medical men abstain more from bleeding at the present day than is good for their patients; that they have rushed from the extreme of profuse and ill judged venesection into the extreme of total abstinence.

"MY DEAR DR. MARKHAM--Since I listened to your Gulstonian Lectures on Venesection, and especially since you told me of your purpose to publish them in a book, I have felt it to be my bounden duty, as a former teacher of medicine, to re-examine and consider afresh the collateral question discussed in them, respecting the so-called 'change of type in diseases.