BOOKS.

College of Physicians in succession to Sir Andrew Clark, and who died on May 29th of the same year, is extremely well written by one who, as Lady Reynolds tells us, was for five years his private secretary as well as his intimate friend. Sir Russell Reynolds was a very different man from Sir Andrew Clark, but there was the same faculty of large and ready sym- pathy in both of them, and the present writer can testify that the remarkable photograph prefixed to this volume gives at once a vivid and happy impression of Sir Russell Reynolds's thoughtful and somewhat anxious face, full of benignity and humour, though full also of the deep sense of responsibility and care. It is not as a medical work that the present writer would think of reviewing such a book as this. Indeed he may at once say that so far as these essays and addresses involve the expression of opinion on any strictly professional subject, he would be absolutely incompetent to pass judgment on them. But for the most part their interest is of a much more general kind, and of one which almost any old student of University College, London, who has taken a keen interest in the leading questions of the day and in the bearing of medical opinion on such great interests as those affecting the principle of Evolution, the teaching of Christianity, and the present state of medical knowledge, is quite able to appreciate. Dr. Russell Reynolds was a keen observer, as every great physician must be, and we may say that his address in 1863 on the different types of medical students as he had observed them, and in 1888 on some past teachers of University College, will have the most lively interest for old University College men, even though they have been concerned with the Arts side, while Dr. Reynolds seems to have known the College only on its medical side. His account of several characteristic types of medical students, though, perhaps, a little touched with caricature, is very shrewd and entertaining, and the much later reminiscences of some of the great medical teachers of the early days of the College, —Professor Sharpey the physiologist, Professor Graham the chemist, Professor Lindley the botanist,—will be full of interest to plenty of the older students of the Arts faculty who were required by the University of London to master the rudiments of some of these sciences. Sir John Russell Reynolds gives characteristic descriptions of the special power and manner of the three teachers we have just men- tioned, though perhaps he hardly dwells enough on the humorous Scotch pawkiness of Professor Sharpey. It was said that on one occasion Professor Sharpey put a simple question on the direction taken by the circulation of the blood to some raw youth, who replied that it went down one leg and up the other, on which the physiologist merely asked with a twinkle in his eye, "And how does it get across ? " But let us extract from this interesting paper Dr. Reynolds's lively account of the first operation under anaesthetics at University College Hospital, where Liston was at that time the great operating surgeon :-

"It may be interesting to many here to recall, and to some others to learn, that the first operation in this country, performed under an anesthetic (ether), was witnessed in University College Hospital, and was done by our great surgeon, Liston. Peter Squire, the father of scientific pharmacology in England, and a friend of Liston, having become acquainted with the use of ether as an anesthetic in America, administered it, experimentally, to his nephew, William Squire, who was then a pupil of our College, and rendered him quite insensible. He was the first to undergo this process in England. William Squire and I were fellow- students, and he administered it to me shortly afterwards, as I wished much to know in what order the senses became extin- guished. Those mixed senses, smell and taste went first, then sight, then touch, and the capacity for appreciating pain, and then—/ongo interact/hi—hearing. They, the senses, came back in inverted order, hearing being an easy winner in the race. The day after this observation was made there was a field day in the hospital, and Liston had consented, at Peter Squire's request, to try the anesthetic. I can see him now, as he said to the students, with playful eye and doubtful, almost scornful month,' Gentlemen, we axe going to try a Yankee dodge for making men insensible. This man's leg has to come off above the knee, and my friend Mr.

• Essays and Addresses. By Sir J. Russell Reynolds, Bart., F.R.S., M.D. Lee President of the Royal College of Physicians. /r.o. London: Macmillan and Co. Squire is going to give him ether, so that he won't feel it.' When Squire was giving the anesthetic, Liston leaned against a bench, trying the point and edge of his long amputating knife and smiling incredulously, as the poor owner of the doomed leg hissed and snorted under the process of inhalation. Ether was not so pure, and apparatus for its administration not as handy, in 1848 as they are in 1888, and so, perhaps, Liston was a little impatient to get to his work ; but at length Peter Squire said, He is quite ready now, Sir.' Liston's knife flashed in the air, I took out my watch to count the time, and the leg was on the floor in six-and-twenty seconds. As if it were yesterday, I remember the expression of Liston's face as he turned round to us students and said,—' This Yankee dodge, gentlemen, beats " Mesmerism" hollow ! ' " (pp. 273-74.) It was a pity Sir Russell Reynolds did not attend the Arts classes. It would have been delightful to compare his accounts of the great philosophical mathematician and quaint humourist, De Morgan, the brilliant Latinist and etymologist, and rather harum-scarum politician, Professor Key, and the refined, the accurate, the exquisite Greek scholar, Professor Malden, with the sketches that have been given of them by other hands. Let us pass on, however, to others of Dr. Reynolds's addresses.

One of the most impressive and sagacious is that on "The Present Position of our Knowledge,"—meaning of our medical knowledge, our knowledge of the misleading effect to which the explosion of certain medical superstitions has led. For instance, the idea that " life " is something quite distinct from the various physical and chemical forces in which life shows itself, that it is some mysterious and separate entity with which physical and chemical and organic processes have no essential connection, has been exploded ; but the dissipation of this superstition has, says Dr. Reynolds, gone too far, and disposed medical men to think and reason as if there were no mystery about the vitality which some patients exhibit throughout physical and chemical and organic processes, and which others fail to exhibit throughout these very processes. Indeed they reason as if there were nothing to do but to elicit by book or by crook signs of organic activity, without considering whether or not by doing so the reserve of living force may not be rather exhausted than increased :- "Granting that we have removed much of the traditional mystery which obscured the facts of life, that we have resolved many so-called living actions into chemical and physical processes, and have described them in other than ' vital' terms, it may still be questioned whether or no we have advanced many steps in the solution of the ultimate and real mystery of life. The tendency of the present day is to believe, and act upon the belief that we have done so ; and, as it seems to me, to push aside awkward facts as irrelevant or unreal, and to smother questionings by representing them as either solved, insoluble, or worthless. It seems to be almost believed by some that, if the chemical elements of which organised and living beings consist are brought together under favourable conditions, they arrange themselves into vital forms and execute vital functions ; and just as certain bodies in solution may assume definite crystalline form, so other bodies may agglomerate into organic form, and exhibit the properties of life." (pp. 142-43.)

And Dr. Reynolds goes on to show how mischievous it often is to assume that only by supplying the chemical conditions of health you may secure health, even though in doing so you stimulate the body to much greater efforts than it has living force to sustain:—

" Again, the view that is taken of the correlation of vital and physical forces, when it assumes the form that I have mentioned, and which amounts to a practical ignoring of the fact of life, is, I think, mischievous in therapeutics. That which is the differentia of life is, as it seems to me, lying in the organism, and is that which makes it capable of transforming physical forces into vital acts. But what we are often attempting to do in our treatment of disease is to elicit vital action, rather than to conserve vital force. We see that, by giving such and such drugs, we change— and as it seems, for the better—the mere processes of life ; we may limit or increase muscular movements ; we may augment the quantity of secretion here, or of excretion there. But, let me ask, do we not often see that, when we have effected these changes, when we have given diuretics, purgatives, diaphoretics, and the like, and have witnessed their appropriate physical results, the disease is no better than before, and the patient is worse ? We have brought vital processes into play, but have used up the vital force in doing so. On the other hand, we try to check what appear to be excessive and exhausting discharges, or tiring and distressing acts ; we try and often succeed in diminishing the frequency, force, or extent of certain vital functions that appear to be, and indeed are, beyond the normal range. Bat, again let me ask, do we not often see, when we have succeeded in lulling a cough and diminishing the amount of expectoration, that other and far graver troubles supervene ; that, when a diarrhoea or diuresis has been cured, the patient is worse than before ; that when a skin eruption has been removed, some nervous

trouble takes its place ? Again, by the administration of alcohol, or of other stimulant or tonic, we may often help a man to get through some work for which, without such aid, he was totally or partially incompetent; we have evoked an amount of vital action that would otherwise have been impossible. But do we not often see that we have really done more harm than good ; that the weakness has increased, and that the necessity for stimulation has become aggravated, and that what was really needed was food and rest, which should have nourished the organism, built up the tissues, and replaced what was wanted in living force ? We have helped our patient to do things he could not otherwise have done, but we have used up his life in doing so." (pp. 150-51.)

In other words, as Dr. Reynolds shows, the abandoning of the superstition that life is something entirely sepa- rate from the various modes in which life is manifested, often runs into the equally dangerous assumption that life is nothing but the various modes in which it is manifested, and that if you can force the body to pro- duce these manifestations you will have restored its health, —a very dangerous fallacy, which has nevertheless produced great results on the actual praetioe of modern physicians. In a very striking passage he shows that, at least to our imperfect scrutiny, there is no difference at all to be dis- cerned between structures so absolutely widely separated that the one is the embryo of the pigeon and the other of the parrot, though the life that results from these apparently identical structures is totally different both in its duration and in its kind :—

" Those simple cells, the germinal vesicles of two eggs—say of a pigeon and a parrot—are much more alike than are the very lowest forme of life and globules of oil covered with a coating of albumen, or suspended in alcohol or water. Neither microscopists nor chemists can distinguish between them ; and yet, by the application to each of them of the same simple force, heat, the one develops into a bird, which, if it escape the gun, has yet but a short term of life, and a very limited intelligence, while the other has a much greater diversity of gifts, and a span of life beyond that of two or three generations of men. If these two cells are really alike, i.e., if there is no difference between them, then their subsequent development is but a series of creative acts, a making of something out of nothing. If they are not alike, but are so far unlike as of themselves to determine all the divergence of struc- ture, function, and durability which exists between the pigeon and the parrot, we must admit the presence of a force to which we know nothing akin, and the existence of the most marvellous differences of property in two objects which we can see through and through, and yet be unable to distinguish from one another. The long word differentiation' affords us not the slightest help in this matter, for all that it can mean is, that a difference pre- existing, but the nature of which is absolutely unknown, become& recognisable by our senses. There must be, hidden in those apparently homogeneous structures, differences of either matter, or of force, or of both, as great in itself as all that which is sub- sequently displayed in the plumage, the habits, and duration of the two birds I have mentioned." (pp. 145-46.) Surely to identify "life" with anything which, at present at least, we can discover in the physical or chemical or even physiological or biological manifestations of life, is to identify the essence and substance with only a very limited number of its properties or accidents. And to get into the habit of thinking that there is no substance or essence, nothing but properties and accidents, is a most dangerous habit, apart from its being almost certainly an untrue kind of thinking, for it leads men to fancy that the few properties or accidents of life which they can see and measure are, and may be treated as, the sum of life, so that the physician who can restore, by stimulating the organs, the only signs of life with which he is acquainted, need never fear exhausting the very sources and roots of life,—a process that is, however, only too common.

In the interesting address delivered in June, 1876, to the Students' Christian Association, Sir Russell Reynolds pointed out with great effect the close analogy between scientific and religious difficulties and the danger of abandoning an old belief which had taken deep root in the mind or heart, only because the student had come across some new fact, or apparent fact, which seemed to be at first sight superficially inconsistent with it. But Dr. Reynolds seems to us to have gone too far when he said that the agreement of large bodies of men in any particular religious or moral belief is the " only widely applicable test of either truth or right and wrong ":—

" The questions that must arise are, whether a belief that needs or leans on such external support is of any value; whether its existence is not a mere emotion, which may run into a sort of hysteria of the soul ; or whether, from this fact of belief, strengthened by association, there is evidence of the existence of a something, which (admitted to be an essential element in what

we call a religion, a `religio,' a binding together of individuals for a common purpose) is a fact the scientific observer should recognise, and to which he should ascribe its proper value ? For myself, I reply to the last query in the affirmative. The scientific observer should observe this fact, and give to it a value which has not yet been given. One of the greatest teachers of the age,

in lampooning universal suffrage, says A nation once voted by an overwhelming majority " Not this man, but Bil FOAM " and then proceeded to show what happened to that nation. And I am prepared to admit that coincidence of feeling or opinion in a mul- titude is not always a proof that the feeling or opinion is right. But I do say this, that concurrence of opinion is the only widely applicable test of either truth, or of right and wrong : and this is the principle upon which all the justice of England is adminis- tered in its trial by jury, and the principle upon which all the Government of this country is maintained." (p. 179.)

But we may be quite wise in insisting that the popular con- science must support a prohibition or a punishment before we allow it to take legal effect, even though that concession is not in the least intended to admit that the popular con- science is the true test of right and wrong. If that were the case it would not be wrong for parents to tyrannise over their children till the popular conscience began to resent it, nor for speculators to swindle gullible people out of their money till the popular conscience cried out against them. Surely every man living must know some one man's conscience whose sensitiveness and delicacy he would infinitely rather trust than that of any crowd or con- stituency in the country in which he lives. It is true that the eager assent of a people to a moral or religious conviction is one test, and a most impressive test, of its truth, but it is not for any one person the most applicable test, and not even for a whole people the most "widely applicable test." During the time of Mr. Gladstone's greatest popularity, we venture to say that his personal assent to each a doctrine as the supposed duty of letting the Irish have their own Government to themselves, —thoroughly mistaken as we thought and think it,—was for

hundreds of thousands a far more safe and sound and " widely applicable test" of political truth than the acquiescence of any popular party in its truth. The popular party believed it for the time because Mr. Gladstone believed it, not for any other reason whatever. They trusted that one great man's

conscience as they did not trust their own. And though we think that in this particular case they were greatly mistaken in so doing, we think they adopted a far safer guidance than any temporary unanimity of popular opinion would have been.

These are very thoughtful, very instructive, and often very

entertaining addresses, and we heartily thank Lady Reynolds for giving them to the public.