By that phrase I mean some change in the human body, existing through considerable spaces or cycles of time, which renders it varyingly affected by the causes and by the remedies of disease, and especially of febrile and inflammatory diseases; so that diseases nominally the same shall, during one period, express themselves in the body more strongly, and during another succeeding period more feebly, and shall accordingly require and bear, now more and now less of what is called energetic, active, depleting, or lowering treatment.

"That this kind of difference, arising from some obscure outward influence, atmospheric, telluric, magnetic, social, or what not, may really be seen in different epidemics of the same disease, will be admitted, I suppose, by all men who have had opportunities of noticing the phenomena of epidemic distempers. But I am obliged to confess that the result of my later reading and inquiries, and of careful reflection on the matter is, that my previous belief in the soundness of the doctrine of a general and more abiding variation of type, in the sense now explained, has been shaken.

"In making this confession I desire to protest against the uncharitable imputation (not made by you, nor especially against myself, but thrown out somewhere, as I gather from Dr. Stokes's address before the British Medical Association) against those who hold or have held the controverted doctrine, the imputation that it was artfully invented to conceal former errors of practice in regard to blood-letting.

แ

Indeed, though I believe that great errors were committed in past years by excess in bleeding, as at the present time by its utter neglect, my own conscience is not uneasy on that score, for I have never been a lavish or a frequent bleeder. I taught, no doubt, because I believed in them, the lessons which I had received from my predecessors, and I endeavored to explain to my class how it was that my practice was apparently so little in accordance with my public teaching. In the first edition of my lectures I say:

"Those among you who happen to be attending the wards of the Middlesex Hospital may wonder indeed, after hearing my estimate of the power of bloodletting over inflammation, that I so seldom prescribe venesection there. The truth is, not that I undervalue the remedy, but that the time for its employment has generally gone by. The poor are unwilling to relinquish the occupations by which they subsist; they struggle on as long as they can, and resort to hospitals only when they are compelled to do so by the exigency of their malady. Many of them, laboring under inflammation, have been freely bled before admission. It is commonly too late when they present themselves to ex

pect that the course of the disease can be so arrested. The first effect of bloodletting is to deplete and relieve the laboring circulation. But when it is again and again repeated, it becomes (as the French say) spoliative; it robs the vital fluid of its nutrient and plastic materials,' etc., etc. (vol. i, p. 217.)

"A careful survey of the facts and arguments adduced on both sides. of late, respecting the alleged change of type, compels me, I say, to suspect that my previous opinion was a mistaken one. In that survey it was needful for me, looking back, to trace, if I could, what were the sources of that opinion, and the retrospect has shown me, I think, the main causes to which it owed its origin and strength.

"First, then, I repeat, I had faith in the judgment of the practicers and teachers of medicine at whose feet I had sat as a learner, that the old fashion of free bleeding in certain inflammatory and other febrile diseases was a right practice.

"But as the field of actual observation and experience enlarged itself before me, I soon found that those symptoms and conditions which I had been taught to regard as the warrant for free bloodletting, very rarely presented themselves; and this fact gave birth to a notion, vague enough at first, that the inhabitants of our great and crowded metropolis, and especially the class of persons who form the bulk of the in-patients in our London hospitals, among whom my experience then chiefly lay, had somehow become less likely to receive benefit from, and less able to sustain, the active use of what are spoken of as lowering remedies.

"About the same time came the teachings of a desolating visitation of influenza (the first that I had seen) in 1833, the year after the first outbreak of cholera in this country.

"The cautions enforced by the influenza, as well as its name, outlived the occasion. The abstinence from depressing measures, inculcated by that depressing disorder, was continued to cognate and extended to other disorders, and this by general consent; and thus men learned the safety and the wisdom of a less heroic treatment of disease in general, and thus the doctrine now called change of type got plausible support; but I believe that the main ground for that doctrine was furnished by the differing behavior under medical treatment of different epidemics of fevers.

"My dear friend, Dr. Latham, one of the most conscientious, careful, and unprejudiced students of disease that I have ever known, had collected (after about ten years' observation as one of the physicians to St. Bartholomew's Hospital) materials for, and was on the point of pub

lishing a book on fever. He had chosen with care his clinical assistants; he had kept regularly and had periodically digested his casebooks and their records; and he found that he had bled from the arm one in every four of his fever patients, and had applied leeches to nearly all of them; and the mortality had been seven in the hundred. "But not long after the first visitation of cholera in 1832, so great a change occurred among his fever patients that he did not dare to bring out his prepared book. Now, he could not venture to draw blood from any of his fever patients. Their condition urgently demanded support, and the mortality among them was doubled. So numerous were the deaths that it was impossible to make any regular inspection of bodies as long as this state of things lasted.

"This looked very like a change of type.

"We know now, but few or none of us knew then, that the diseases with which Dr. Latham had been dealing were, not varying types of the same malady, but two diseases differing in species; the first having been enteric fever, the second typhus.

"In this way, and to this extent, I readily admit that modern improvements in diagnosis have modified on grounds of reason, our practice. "I remember, also, to have read Dr. Caleb Williams' address to the British Medical Association on the "Change of Type in Disease," in which he adduced his own experience and convictions on that topic, and gave some account of Autenreith's work, to the same effect.

"Again, and more lately I remarked (and the fact tended to strengthen my faith) a great consensus of opinion among medical writers upon the alleged change of type who had lived and practiced in the period when the change was supposed to have manifested itself, while it was chiefly questioned or denied by younger men, whose personal experience had not included that period.

"I trust that I may now have convinced you that the opinion combated by you (which I should be ashamed if I had not candor or courage enough to renounce, or at any rate to doubt, upon good cause shown) was not formed at random, nor without supposed foundation for it, still less adopted as a miserable cover or excuse for former bad practice.

"I suspect that, in a sentence of mine which has obtained an unhappy prominence in this controversy, I ought to have spoken of successive waves' of 'opinion' rather than of 'time.'

"Believe me, very truly yours,

-[British Medical Journal.

"THOMAS WATSON."

We invite the attention of our readers to the following editorial in the London Lancet, December 15th, as it bears upon a point which, strange as it may appear, has never, we believe, been brought before the National Association :

"Amongst the many subjects incidentally suggested to the mind in the course of the recent trial of Hunter v. Sharpe, is the question of the state of English law in reference to foreign and colonial degrees. At present our law does not recognize them; or, to speak more accurately, it only recognizes such as were obtained prior to the passing of the Medical Act, and this with certain restrictions. Registration of foreign and colonial degrees and diplomas can only be procured under the provisions of the forty-sixth section of the Medical Act, and those of the eleventh section of Schedule A to the Act. Accordingly it is necessary for the registration of such degrees and diplomas that they shall have been obtained, after regular examination,' and before the passing of the Act. It is further necessary for the registration of any such degree or diploma, that the holder of it should have been in practice, as a physician or surgeon, as the case might be, within the United Kingdom before the first day of October, 1858. The Medical Council have properly observed the utmost care in registering foreign degrees, even within the above limits. In 1859 it passed resolutions to the eftect that in any case of application for the registration of a foreign or colonial degree, the Registrar should institute strict inquiries, by letter addressed to the university or college represented to have conferred the degree, as to the genuineness of the document produced to the Registrar, and as to the regular examination of the person producing it. We have authority for saying that in no instance of the registration of foreign or colonial degrees or diplomas have the foregoing rules been deviated from. The Council can not be too highly applauded for its excessive care in this matter, as exemplified in its resolution of 1859. We are not quite sure, however, that the law itself on this subject is creditable. We should be disposed to advocate the registration of all respectable foreign and colonial degress as an act of national, or rather international, respect and good will. Just as we would wish in New York or in Paris to be treated and respected as medical men, so we should wish to accord to all worthy graduates of New York or Paris, or any other great school of medicine, the same honor and the same right of practice as we accord to the holders of British degrees. Let the Council take any steps it pleases to ascertain

the nature of the curriculum required to obtain any particular degree, and, on being satisfied on this point and on the personal respectability of any holder of the said degree, let it be free to register it. According to the present state of the law, Professor Trousseau, of Paris, or Dr. Flint, of New York, were they disposed to practice in London, could not be registered without examination. Their present qualifications would be simply ignored. This, we submit, is not the ultimatum of professional generosity. It is true that all graduates of Paris are not Trousseaus, and all graduates of New York are not Flints; but it is by the law affecting the many that the feelings of great nations are influenced. A little generosity here on both sides would cement the profession throughout the world. It would only be the expression in our law of a feeling of respect which every foreigner meets with in our medical societies. Not long since, physicians and surgeons of Edinburgh were unqualified for medical and surgical practice in London. We are all ashamed of that narrowness now. In the present condition of the law in regard to foreign and colonial degrees there lurks a remnant of this narrowness."

It is indeed refreshing to read in a journal of such influence as the London Lancet sentiments so liberal and just. The utmost generosity has already been extended to members of the medical profession from Great Britain, who have thought proper to select this as the home of their adoption, but as the Lancet truly observes, it is about time that this "one-sided reciprocity" were ended. If merit were the qualification required by British laws to entitle the practitioner to deal with the health and lives of British subjects, what multitudes could be found in our country equal, if not superior to many who have a legal qualification to practice there, and who when they choose, emigrate and enter without restraint into competition with the profession of the United States, although a Flint would be debarred that privilege in Great Britain? Should any doubt our assertion in reference to the comparative merits of many British and American practitioners let them examine the reports made during the past year to the British Medical Council, and they will be amazed at the low estimate placed by her own. best judges of the actual qualifications of large numbers who have succeeded in obtaining the diploma of the Royal College of Surgeons. But the editorial we have quoted breathes too noble a spirit to warrant unkind remarks, and we gladly banish this unpleasant topic, resolved to cherish only what every American who has mingled with the profession of Great Britain, must truly feel, viz.: sentiments of gratitude and admiration. G. C. B.