of great advantage alike to patients and medical students. In the eye department, for instance, they had all the latest developments for operations-dark room for ophthalmoscopic cases, and new electriclight apparatus for examining the eyes, &c.

After looking round the wards, Professor A. E. Wright gave them a lecture on that intricate subject-the therapeutic inoculation of bacterial vaccines. To put it simply, it amounts to this-that disease due to bacteria may arise either in consequence of their mere presence, or in consequence of the action of their poisonous products. Now the body of a healthy person does not suffer patiently this foreign invasion, for Nature has provided the blood with the allimportant white cells called phagocytes, which are there to oppose and destroy, if possible, the invaders. In some diseases the attack is made mainly on the bacteria, these little specks we see under the microscope, which are taken up, devoured, and digested by the transparent white cells called phagocytes. In certain other diseases the fluids of the body generate substances (antitoxins) which have the power to render innocuous the poisons produced by the action of the bacteria. There is, however, a third group of diseases which has proved refractory to each of these remedial measures provided by Nature, and it is here that Professor Wright has stepped in by endeavouring to combine both procedures, and to apply his conception practically. It is not difficult to understand that when a patient is sinking under disease it may be due either to the invasion of bacteria in too great a force for the white blood-cells (phagocytes) to deal with, or to failure to produce enough of the antidote to neutralise the poison created by their action. Professor Wright, by uniting the observations of the French and German schools in these directions, claims that by special treatment it is possible to cause the body fluids of unresponsive patients to acquire or reacquire the power so to prepare or affect the bacteria that they become, as it were, served up in a less inimical form, and are then greedily devoured by the white cells of the patient, who, without this treatment, would or might long continue a victim to their ravages.

We must now leave the metropolis for the moment and follow the French doctors to the School of Tropical Medicine at the Albert Docks. Here, once again, they were struck by the propelling influ ence of our late Colonial Secretary, Mr. Chamberlain, whose keen recognition of the benefits likely to arise did so much to establish this new branch of research in our midst. The hospital, being 80 close to the docks, receives patients from all parts of the East, who step in, or are carried in, straight from the ships. The reception hall presents an aspect truly oriental, with the turbaned sick sitting round in every attitude of suffering, awaiting their turn for medical atten

tion.

Here they were shown the large new laboratory, with thirty-six

students at work, the residential quarters, mess-rooms, museum, &c., and more recent additions to tropical pathology, as the Tympanosoma Gambiense, the reputed cause of sleeping sickness, and the recognised cause of a grave form of recurring fever in tropical Africa to which more than one European has already succumbed.

They were also shown the newly discovered Leishman body-a disease germ which promises to occupy a very important place in the growing list of tropical pathogenic agents. It is now recognised as the cause of what used to be called 'malarial cachexia' (or at least one form of malarial cachexia), and is probably the germ cause of Oriental sore, known locally as Delhi boil, Scinde sore, Bagdad boil, &c. Besides these curiosities they were shown microscopic preparations illustrative of the various tropical disease germs and their lifehistory, in insect and other intermediaries. In the tropical wards of this hospital they were shown cases of leprosy, beri-beri, dysentery, liver abscess, malaria, and a variety of other diseases of tropical origin.

The school, recognising the importance of the study of protozoa and other kinds of animal parasites, is about to establish (funds permitting) two new chairs, one for medical protozoology, and one for medical helminthology, subjects which have not hitherto received the recognition they deserve either in our laboratories or in our teaching institutions. It is felt that the scientific study of the grim causes of tropical diseases is the best foundation for scientific treatment and prevention.

The Frenchmen were much impressed by the spaciousness, cleanliness, discipline, and comfort of the wards, and by the variety of races represented by the patients.

At the Westminster Hospital great interest was taken in a patient —a young man—suffering from a disease which is fortunately very rare. It is rapid paralysis, beginning at the feet and spreading upwards till all muscular power throughout the body is lost in fifteen days. The origin of this malady was diagnosed as being in the spinal cord, and accordingly a syringe was plunged into his back and some of the fluid drawn off and placed under the microscope. Away up on the wonderful roof of this hospital is a clinical laboratory, and here the fluid was examined and the cause of the disease discovered in a microbe distinguished as the 'tetracoccus '-simply four little black specks clustered together forming a square, and many such appearing in groups.

Under proper treatment recovery began at the head and continued steadily downward till the lost power was recovered, and now, like many hospital patients, he was very much pleased with himself.

The operation room in this hospital is quite up to date, with an adjoining vestibule for the administration of chloroform before the patient is wheeled into the pale green-tiled chamber, where every

thing-surgeon, assistants, nurses, instruments-is ready and awaiting him.

On the roof new rooms have been built for the use of the Röntgen rays, electrical bath, &c., and communicate by covered ways through the open air like cloisters.

At the National Hospital for the Epileptic and Paralytic the French doctors saw Sir Victor Horsley remove a tumour from a man's brain, the man being completely paralysed. A few days later I could testify personally that the man could move his legs and arms quite freely, and, although not allowed to raise his head from the pillow, was enjoying a generous slice of Swiss roll and a very good tea. The man was still filled with astonishment at the sudden change in himself. The ward in which he lay was close to the operating room, and is kept specially for these cases. While operating the surgeon wears an electric lamp fixed over his forehead, by which he is enabled to see right through the brain. Here, again, may be seen a perfect operation room, all white tiles and tessellated pavement, with an electric fan to cool the air, and radiators to warm it. In an anteroom the patient is put under the anaesthetic, and in a vestibule a row of indiarubber boots of all sizes stands ready for nurses and assistants to save them getting wet feet by standing in pools of water during the operation. On a rail hangs a row of thin indiarubber gloves, ready for the use of surgeon and assistants.

In another ward a woman had to go through a remarkable process of stretching the neck every day to cure trembling-a form of paralysis agitans of the head. When asked if she liked it she shook her head, but smiled when the nurse brought forward the 'gallows' to show how it was done. It was one of the cases where this particular treatment was found to do good.

At St. Bartholomew's Hospital the French doctors had an opportunity of seeing how our oldest and best endowed hospital could carry on excellent work under all the disabilities of old age. Could these ancient walls speak, they could tell many a tale of hopeless suffering in times gone by, suffering which no benevolence could relieve while the true cause of disease was unknown, and surgeons, in giving relief with one hand, dealt death all unconsciously with the other. A large picture on the wall shows the surgeon pouring oil and wine into the wound of a patient, a custom resorted to from ancient times as a healing measure; but there was no scientific knowledge to direct and improve upon this early effort at antiseptic treatment, and without safeguards little good was done. Again, Ambroise Paré's method of searing the wounds with red-hot irons was a further attempt at antiseptics, but often failed to save where shock from suffering killed. The walls that once were death-traps are now kept scrupulously clean, and the homely comfort of the wards, the excellent food and good nursing, excited the admiration of the doctors. On the top

floor were wards for children suffering from infectious diseases, one ward being rigorously shut off from another. The ward set aside for diphtheria excited much interest, as the cases were all treated with the anti-diphtheric serum worked out by Dr. Roux, of the Institut Pasteur, the serum of all others found to be the most certain in its immediate effects if given early enough. In the medical wards were several cases of typhoid fever. One was that of a young man, the victim of oysters, who had had two relapses and was in the eightyfirst day of his illness. Another case was that of one of the Queen's Jubilee nurses, who lay, with flushed cheeks, looking very ill, but hoping and longing to get back to her work among the poor of the London slums.

Here, as in the London Hospital and other great hospitals of London, the neat appearance of the nurses, their perfect training, and numbers, excited not only the admiration of the doctors but their envy. In Paris, since the sisterhoods had been scattered, the gaps had never been filled up, and the difficulty of getting nurses was a real one. It was feared that French mothers would never consent to allow the freedom necessary for daughters who might desire to follow this vocation and make themselves useful in a sphere where their services are required, not only at home, but in the colonies and all the world over.

Of the many hospitals visited by the French surgeons and physicians there was just one which was far from disposed to open its doors, owing to an unhappy consciousness of being out of date. This was King's College Hospital, which never ceases to proclaim its readiness to move to a less expensive neighbourhood when the public provide the necessary means. The site for this new hospital has already been given by the Hon. W. F. D. Smith, M.P., and the site of the old will yield an income of 6,000l. a year; but, pending the hoped-for change, the hospital as it stands is not proud of itself in these advanced times. It has become what the Scotch call 'cassyfaced,' anglice causeway-faced-that is, a disposition to keep in the back streets rather than be seen in the front. Still, drawbacks notwithstanding, this was the hospital the French doctors elected to see, and accordingly drove up, a considerable party, one morning at eleven o'clock, and asked permission to visit Lister's theatre. The most advanced hospital in the world had little interest for them compared with the hospital where Lister led the reform of all surgical practice by the introduction of true antiseptics thirty-five years ago. The theatre, with the semicircle of raised benches, is still what it was in his day, and is still doing duty as operating theatre and class-room combined-a combination now universally condemned. With all the surroundings just as they were in Lister's day, the operating theatre had an archaic interest for the French that nothing else had. It was the centre whence modern teaching spread to all other London hospitals.

It was here the reduction in mortality told its own tale. With the fundamental principle everywhere adopted and universally the same, this 'cassy-faced' hospital forms the keystone of all the proud edifices that have since been reared in all parts of the civilised world for the care of the sick and the scientific education of medical men. Reflecting on all these things, it must have struck our intelligent neighbours as a curious irony of fate that left this hospital behind in the general advance, a parent repudiated by her children, when of all hospitals this should stand out a model to the world, and a monument to the reformer to whom the world owes so much.

While the French doctors were always ready to accentuate their profound respect for Lister, the English were not behind in acknowledging all that we owe to Pasteur, and to that early entente cordiale that existed between these two men when they formed, in the teeth of fierce opposition, a 'brotherhood of science labouring to diminish the sorrows of humanity.'

As we are all now aware, Lord Lister was the first medical apostle who believed in the word of Pasteur. The word was conveyed to his brain while sitting in his armchair (at Glasgow) reading Pasteur's researches sur les corpuscules organisés qui existent dans l'atmosphère. We can imagine him, with attention riveted on all he was learning, as it gradually dawned on his mind that herein lay the whole explanation of things going wrong with wounds. It was the drawing up of a curtain that revealed to him the immense possibilities which have since been realised.

In the Institut Pasteur we have a living, working monument raised by the contributions of all nations to honour for ever the name of Pasteur. In a beautiful tomb he lies in the crypt down below at rest; but the words he wrote to his father on receiving the prize for experimental physiology from the Academy forty-five years ago seem to rise from that tomb like a prayer that has been heard-' God grant that by my persevering labours I may bring a little stone to the frail and ill-assured edifice of our knowledge of those deep mysteries of life and death, where all our intellects have so lamentably failed.'

Let us, then, welcome the entente cordiale so happily begun, and do our share in encouraging scientific research and spreading the knowledge gained over every part of the earth. By this means alone can we hope to save suffering and needless death, with all the miseries that haunt the track of ignorance, and do so much to overshadow the brightness of our homes.

ELIZA PRIESTLEY.