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some of the animal fat, and rub it well in with a piece ofpumicestone. However brittle and hard the epidermis maybe, it is quickly removed, sometimes in large pieces, leavingthe subjacent skin smooth, soft, and supple. This causesno contracture of the skin, and consequently no cracks orfissures. The skin does not accumulate for twenty-fourhours, more or less. We repeat this procedure every secondor third day, after each sitting smearing the surface with alittle napthol lanoline pomade. The same object as theabove can be achieved by using the salicylic plaster muslinof Unna, but it has this fatal disadvantage-it requiresconstant application, whereas my method requires no strap-ping or bandage whatever. (b) Internal. Small doses ofliquor potassæ —half a drachm or less soon after food-prove eof great service. How this acts I am not in a position toexplain. It may be that it helps the assimilation of thefood by emulsifying fats, or perhaps it prevents those fer-mentative changes which I believe take place in theblood of many eczematous patients.

. 2. Dietetic medication.—Regular meals should be adopted,and in the majority of cases three a day. Tea should bepartaken of only once a day, cocoa supplanting it at break-fast. Meat, not with too much indigestible fat to it, andwith fresh vegetables, followed by fruit, should be allowedonce, and this at dinner. Take old bread in place of

potatoes, and brown instead of white. It matters not whatthe diathesis of the patient-he should avoid alcohol in anyform, all pastry, sugar, and such other circulatory excitants.

3. The hygienic and general indications are to clothe thesufferer in woollen garments, whatever the season, the lightmaterials being worn in summer. An equable temperatureof the whole body is thus maintained, and the deficientfluid secretions of the hand accounted for. Proper andsufficient exercise must be indulged in, a pair of kid glovesbeing worn during the day. The patient should sleep in awell-aired and lofty room, with the window slightly open,in a woollen sleeping suit. Some cases have undoubtedlysome relation to incontinence in sexual matters ; thereforethe moral surroundings should be looked to. I generallytell my patients, whatever portion of the body the eczemaaffects, that they are to wash the parts once only everythree days, so necessary is it to keep them absolutely dry.More frequent ablution is not necessary-nay, is positivelyhurtful. These minor details are collectively and indi-vidually of great importance, though at first sight theymay not seem so. They assist the local treatment to alarge degree, and, unless we pay attention to every one, wemust expect what in any case is likelv to happen-namely,a relapse of the eczema palmaris. The statements underheadings 2 and 3 are applicable to all forms of eczema, andwhatever their position.

I am, Sirs, yours obediently, - - -

Stokesley, Sept. 1888. J. A. WETHERELL, M.B.

THE PROTECTION OF THE MEDICALPROFESSION.

To the Editors of THE LANCET.SIRS,—I think it is decidedly for the profession, as a body,

to take steps to protect themselves, as it is perfectly futileto expect the Medical Council to take direct steps on ourbehalf-that would be altogether out of their sphere ; theymay help and direct, but I do not see how they can go beyondthat. Of one thing, however, I feel sure ; and that is, thatTHE LANCET at least will render a very ready and helpinghand, as in my experience it has always done, to any reallygood cause. Now as to the question what is to be done, andhow best to do it. I think the onus lies on the rank and fileof the profession to take action, for if some joint and heartyaction is not taken, we had better let things remain as theyare, and be content to grin and bear it. 1 myself have hadnow over a quarter of a century’s hard work in the pro-fession, and I have only to look back and contrast thepresent state of the profession with its state twentyor thirty years ago to see how it has fallen in status.Acts are now unblushingly done which no gentlemanwould have dared to do in former times. Further,we see, owing to the unnecessary competition, the bene-ficent intiuence of sanitary science, and other causes, ouremoluments gradually year by year getting less, whileevery day numbers beyond the real wants of the publicare crowding into the profession, and so reducing incomesto a starvation point. I could bring forward endlessgrievances and abuses as they now exist, but it is out of

the question to ask you for space for that-that can bebetter done by and by. I will. however, do this : if anyreasonable number of the profession will help me, I will tryto establish a league to bring about a more healthy stateof affairs, so that we may happily become again a bodyrespected and remunerated as we once were-a state ofmatters that will be for the joint benefit of us as a pro-fession and of the public at large.—Yours truly,September, 1888.

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J. H.

PULMONARY TUBERCULOSIS.To the Editors of THE LANCET.

SIRS,—Your leaders in to-day’s issue on tuberculosis andinhalations are refreshing. Tuberculosis is not a contagiousdisease-at least in the same way that syphilis or typhus iscontagious. A man in good physical health cannot contract

tuberculosis. This disease arises when every possibility ofcontagion is excluded. A diligence driver died of phthisisat Wiesen. There was no history of phthisis in his case,and there had been no death from this disease in the villagefor years before. An insanitary dwelling-house, indiscre-tions, and more bad native wine than wholesome food causedhis disease. We all know instances of phthisis in countrypatients where contagion was impossible. The friends ofthe phthisical in the large Swiss Kursaals do not con-tract phthisis, and during winter about nineteen hours ofthe twenty-four are spent in-doors. We send a patient inthe early stage of phthisis to Davos or Wiesen. His sputaare full of bacilli. He takes no physic, uses no inhalations,but lives well, and exercises freely. He returns afterseveral months completely restored in health, and there areno bacilli in his sputa, if there be even any sputa. Bacillicome on the scene during an abnormal constitutional state,and they disappear on the return of the normal conditionof health. Where is the evidence that the bacilli causethe phthisis ? We do not require guinea-pigs in the debate.We have the disease in man plentiful enough. Bacilli are

present when phthisis is active. This is the sum of ourknowledge of these organisms. If we cremate all thephthisical animals in the world, there is no reason whyphthisis should not go on afterwards, as it does now.Koch would have us all bacteriologists. Verneuil holds

that inoculation would be better, and suggests that weshould all keep a supply of guinea-pigs for the purpose.Perhaps the bacilli scare is best treated by ridicule, and toarm each of us with a microscope and some guinea-pigs, asthe Frenchman advises, is a distinct step in this direction.Rectal injection of sulphuretted hydrogen is another. Ifanyone will charge a chamber of air impregnated withbacilli, I shall breathe it as long as he likes. I sentyou a paper several days before the Glasgow meetingin which I repudiated inhalations in phthisis, and I ampleased to be supported by authorities like Williams,Lindsay, and Denison. I do not think you are warrantedin thinking Listerism a success. Lister attacks the germs.Lawson Tait would remove or change the pabulum onwhich they feed. In my experience Tait’s teaching is rightin surgery, no less than in medicine.

I am. Sirs. vours obedientlv.

Southport, Sept. lst, 1888. JOHN LOWE.

MEDICAL EDUCATION IN FORMER DAYS.To the Editors of THE LANCET.

10 tlte Editors of THE LANCET.

SIRS,—The pages of THE LANCET will soon be repletewith accounts of the present state of medical education, andadvice as to how it should be conducted. Could you findroom for some account of medical education a century ago,copied from manuscripts in my possession ? They werewritten in reply to inquiries from St. George’s Hospital in1792, when a controversy on this subject had arisen betweenJohn Hunter and his colleagues. With your leave I willforward the Report from St. George’s Hospital on this sub-ject later on. I have copied the manuscripts without anychange, orthographically or otherwise, as they show thestyle of writing at that time.

I am. Sirs. your obedient servant.Sept. 19th, 1888. CHARLES HAWKINS.

" Hatton-garden, Dec. 29th, 1792.DEAR SIR,-When I first became acquainted with the two hospitals

of St. Thomas and of Guy, which was in December, 1734, the establishedrules of those hospitals- at that time were that each surgeon was per-