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fatal last week, 335 deaths being registered under this head,against 371 in the last return.

SIR WILLIAM MUIR, the Director-General of the Medical

Department of the Army, has, we regret to learn, been

seriously indisposed. We have great satisfaction in beingable to announce that he has recovered, and is able to

resume his important duties.

THE PROVINCIAL MEDICAL SCHOOLS.

HAVING already published the return of medical studentspursuing their professional studies at the metropolitan hos-pitals for the present session, showing a large increase overthe number of 1876, we now publish a similar return fromthe annual report just forwarded to Mr. John Birkett, theGovernment Inspector of Provincial Anatomical Schools, bythe Royal College of Surgeons, from which it will be seenthat there is also a good increase at some of these insti-tutions for the present session and a large total over thelast :- 1877. 1876.

Owens College, Manchester ...... 114 ... 110Leeds School of Medicine ......... 69 ... 54

Liverpool Infirmary School of Medicine 50 ... 53

Cambridge University School...... 28 ... 42Durham University Coll. of Medicine 37 ... 31Bristol Medical School ......... 34 ... 40

Queen’s College, Birmingham ...... 57 ... 34Sheffield Medical School ......... 22 ... 17

Total ...... 411 ... 381It will be seen that there is an increase of 23 at Birming-

ham, 15 at Leeds, 6 at Durham, 5 at Sheffield, and 4 atManchester. The schools which have fallen off are-Bristol

by 6, and Liverpool by 3. The total number of provincialstudents this session is represented by 411, against 381last year, being an increase of 30. The total number of

gentlemen, therefore, who have duly registered themselvesat the Royal College of Surgeons as pursuing their pro-fessional studies at the recognised metropolitan and pro-vincial schools is represented by the large number of 2333,being an increase of 208 over the corresponding period oflast year.The following comparative table exhibits the number of

medical students in the metropolis and in the provincesfrom 1867 to 1877 inclusive :-

Year. Metropolitan. Provincial. Total.

1867 ...... 1125 ...... 257 ...... 13821868 ...... 1194 ...... 284 ...... 14781869 ...... 1241 ...... 330 ...... 15711870 ...... 1298 ...... 357 ...... 16551871 ...... 1475 ...... 368 ...... 18431872 ...... 1496 ...... 402 ...... 18981873 ...... 1650 ...... 455 ...... 2105

1874 ...... 1745 ...... 453 ...... 21981875 ...... 1769 ...... 398 ...... 21671876 ...... 1744 ...... 381 ...... 21251877 ...... 1922 ...... 411 ...... 2333

The present year, therefore, represents a larger totalthan has been known since the establishment of the

registration, which we are now informed is abolished,to the great satisfaction of metropolitan and provincialteachers and students, as well, we should think, as of thecollege officials, especially Mr. Stone, upon whom the dutyhas devolved for nearly a quarter of a century of registeringthe large army of young doctors, as shown above, who havepassed through his office.

THE managers of the Western Infirmary, Glasgow,have instituted a department for Diseases of the Ear, underthe charge of Dr. Thomas Barr.

Correspondence.

HYDROPHOBIA.

THOMAS WATSON.

To the Editor of THE LANCET.

SIR,—In THE LANCET of October 27th reference is madeto an astounding statement made by Inspector-GeneralBalfour to this effect: that of eighteen persons bitten by arabid dog, the wound of one was excised, and cauterisedfreely by a blacksmith’s iron; two years afterwards thisman remained well, but within three months of the bite theother seventeen bitten persons were dead. This enormousfatality is so unique that I shall deem it a favour if youcan refer me to the Inspector-General’s statement. I ven-ture to trouble you on this matter because a paper of mineon Rabies and Hydrophobia will appear in the next issueof the Nineteenth Century Review.

I remain, Sir, very faithfully yours,THOMAS WATSON.

Henrietta-street, Cavendish-square, Nov. 5th, 1877.

Inspector-General Balfour, in his letter, which ap-peared in our issue of Oct. 20, p. 599, relates a case whichfell under his observation 11 about the year 1861 or 1862;"in connexion with this case the statement to which SirThomas Watson refers-namely, " that of some seventeenor eighteen persons bitten at the same time not one wasthen alive," appears to have been made to Inspector. GeneralBalfour by 11 a friend." We have no means of attesting thenarrative.-ED. L.

"BIOGRAPHY EXTRAORDINARY."

JAMES PAGET.

To the Editor of THE LANCET.

SIR,—I shall be obliged by your allowing me to statethat the biography to which you referred in your last numberwas written and published without any consent or know-ledge of mine. I have not seen the journal, and I have noreason to believe that I know either its editor or the writerof the article, or any one connected with either of them.Perhaps I might venture to believe that no one wouldthink me likely to sanction the publication of my life, or

anything of the kind, but I am not willing to let the leastdoubt exist on this matter. I therefore beg you to allow meto state plainly my complete disapproval of the publicationto which you have drawn attention, and my belief that allsuch things are very injurious to the reputation of our pro-fession.

I am, Sir, obediently yours,JAMES PAGET.

Harewood-place, Hanover-square, W., Nov. 5th, 1877.

"HYSTERICAL ANÆSTHESIA."To the Editor of THE LANCET.

SIR,—Will you spare me space for a few observations onthe very interesting discussion which arose at the last

meeting of the Clinical Society of London upon a case of

hysterical ansesthesia, communicated by Dr. Henry Thomp-son, and a paper by Dr. Coupland on the same subject, inyour last issue (THE LANCET, Nov. 3rd).The preliminary question raised may, I conceive, be

stated with sufficient clearness by converting one of the

many perspicuous statements in Dr. Coupland’s able paperinto a syllogism, thus :-1. A protean malady can have nosimple etiological foundation. 2. Hysteria is a proteanmalady. 3. Therefore hysteria can have no simple etio-logical foundation.

I join issue on the major premiss. A "malady" is astate compounded of objective and subjective departuresfrom the normal, some of which constitute symptoms.It is a purely arbitrary act, justifiable only on the groundof convenience, to give two cases of the same so-calleddisease, a common name. The conditions are never identical,and it is not possible, in any scientific sense, to do more

705

than make out a degree of similarity which will sanction theuse of a common term. The practice of grouping cases anddistinguishing particular combinations of symptoms byterms more or less intelligently applied, is, of course,necessary, but we must never lose sight of the fact thatcalling a series of phenomena, "hysterical" does not makeit so. I am not thinking of gross errors of diagnosis, but ofcases well worked out, still not on that account identical.When, therefore, we speak of a " protean malady," it is need-ful to bear in mind that we are fully as likely to be makingout the quality of proteanism, by a Frankenstein process, asrecognising varieties of the same so-called disease. Thecaution to which I would point is indispensable in dealing withhysteria in all its manifestations, or, as I prefer to say, thevaried physical and mental disturbances commonly associatedunder the term" hysterical." In a medical sense, therefore,we must, I think, reject the postulate which Dr. Couplandoffers when he says, "Clearly so protean a malady (ashysteria) can have no simple etiological foundation."Meanwhile, I am quite prepared to admit that " it is but aconfession of ignorance on our part to refer it invariably toa single source." I was not aware that physicians did referhysteria "invariably to a single source," but perhaps thatis a proof of my ignorance; so pray let it pass.We know little or nothing of hysteria; and I venture to

think our information is scarcely likely to improve whilesymptoms are raised to the level of diseases, and contingentphenomenal disorders are treated as primary affections-forexample, so long as physicians report cases of " catalepsy,"as though the cataleptic condition could be pathognomonic.In nineteen out of twenty cases of what is roughly called"mental disease" the cause is physical, and the mind sym-ptoms are reflexly induced. Nevertheless I think patho-logists fail in ignoring the purely mental phase of morbidaction; and, while they are not slow to recognise the physicalcauses of mind symptoms, they are too prone to overlook thepossibility of direct mental causation of disordered statesand disturbances which seem wholly physical. This maysound like an old story, but it needs to be recited in a newform.

Dr. Henry Thompson, as I understand the controversy,recognises the presence of mental forces as elements in theproduction of the state called hysteria. Dr. Althaus discardsthe hypothesis of their operation when he can exclude thepresumption that patients intentionally or consciouslydeceive themselves or others. In fact, he does not conceiveit possible that mental forces should act without thecognisance of the subject. Dr. Broadbent would seemto be open to conviction, but finds himself face to face witha difficulty he cannot surmount. Mr. Brudenell Carterwould be in the same predicament, but, being a bolderman, he takes the obstacle at a flying leap. His solutionof the problem may be paraphrased thus: 11 What youcannot understand do not believe; set the mystery down tcthe imagination of the patient, or his wilful and ingeniousimposture." This is a facile mode of reasoning, but it is notscientific. In short, Mr. Brudenell Carter’s hypothesis of de.ception had no place in the argument. If the " facts " werefictions, no more needed to be said on the subject, exceptperhaps to point out the stupidity of the observers duped,I must leave Mr. Brudenell Carter to settle the imputationwith those upon whom it was cast. Dr. Glover was amplyjustified in asserting 11 that the time had come for a mor(careful investigation into the various forms of anæsthesia."He might have added ischæmia and many other mysteriousphenomena to the list.We want a better word to use in the place of "mystery."

The unknown is not necessarily unknowable; it ma3simply mean unexplored. I venture to think what s<

grievously puzzled the disputants at the Clinical Societ3the other night falls under this description. It is curioulto observe the manner in which extremes meet in a discussion carried on without guiding lines of reasoning. Nota few of the views broached on this occasion were worthyof the earlier centuries in the history of medicine. Thealchemists would have gloried in the mystic laudation ogold. It seems to have been forgotten that so simple afactor as the difference of specific gravity in coins used in theSalp&eacute;tri&egrave;re experiments may have produced widely diversephysical effects on the surface nerve-organs, and whethe:by a piece of gold or a brass garter kept in apposition with the skin, the terminal filaments migh

be stimulated, mechanically-as titillation, or the gentlepressure of a substance so soft as the hand, will sometimesrelieve severe pain and induce sleep. The great point for-gotten, however, was the undoubted connexion which sub-sists between mind and body, and the strange way theyreact upon each other, even during the state known asunconscious cerebration.Almost anyone who likes to try the experiment honestly

will find that he can by practice obtain such controlover his sensations as to extinguish the sense of pain.The old flagellists and self-torturers of the ecstatic

sects did not so much overcome the sense of suffer-

ing as destroy it by establishing a condition of anaesthesiaby mental effort. The proof of this can be, made by directpersonal experiment, and what is capable of being done byway of inquiry is daily accomplished in morbid conditionsof the brain. The experience of medical superintendentsof asylums will bear me out in asserting that, under the in-fluence of disordered mental states-for example, delusions-individuals of highly sensitive temperament will endure whatshould be agony, while the fact that the anaesthesia, in onlytemporary is found in the fact that in dressing the woundsself-inflicted, or almost preternaturally borne by thesepatients, they suffer acute pain. I am not drawing onmy imagination for these facts. I distinctly affirm that theEtatement is truthful. Again, as regards the iseboomis,wounds do not always bleed when the attention ispowerfully diverted, as in the case of injuries receivedunder intense excitement in battle. The haemorrhage notunfrequently commences after the excitement is over.I differ from Dr. Coupland as to the production of such a,phenomenon as blushing or pallor. I am convinced byex-tensive observation and experiment that not only the heartbut the arterioles may be brought under the control of thewill. It is even possible to cure the condition of hyper-sensitive vascularity, which causes blushing on the slightestprovocation, by the roundabout process of making the actvoluntary, and thus bringing it under control. In the sameway some inveterate cases of chorea have been cured byconverting involuntary acts into a subjective result ofvolition, and, so to say, bridging over the chasm betweenimpulse and will. Some forms of stammering may be suc-cessfully treated in this way. The victims of the involun-tary muscular contraction or spasm which breaks the rhythmof the voluntary act intentionally produces the jactatoryphenomenon, and thus obtains the mastery. I am notspeaking of cases in which the impossibility of maintaininga continuous muscular contraction is the result of weak-ness, when increased effort may cover, and, in process of

, time, cure the defect.To sum up, I believe " hysteria" to be a misleading term

. for conditions very different in their nature, and springing

. from totally distinct and dissimilar causes. When the nameis discarded we shall find the artificial group of morbid

! phenomena, fall apart to the great advantage of science.; Investigation is what we now need, and I venture to urge- that the scope of the inquiry must include what seem to be

purely mental states. It is one of the regrettable con-

i sequences of making a specialty of " mental disease," in. which the mind symptoms of physical disease are arbitrarilyfilched from medicine to compose a mock science of "psy-chological medicine," that this great and important subject

cannot be adequately studied. If all that is available in’ the way of evidence could be brought to bear upon it in a,! single focus the mystery could probably be dispelled.

Tam. Sir- yours, &c.

Scientific Club, Savile-rowJ. MORTIMER GRANVILLE, M.D.

UNIVERSITY OF LONDON.PROPOSED EXTRAORDINARY MEETING OF CONVOCATION.

To the Editor of THE LANCET.! SIR,-In justice to those who have signed the requisition

about to be placed in the hands of the chairman of Convoca-tion, you will, I hope, allow me to offer a few words of ex-planation.At the meeting of Convocation on May 9th, 1876, a reso-

lution was passed, without division, that a special com-mittee should be appointed "for the purpose of consideringwhat changes in the constitution of the University are de-