knowledge on which the scientific witness is liable to be questioned. This renders it necessary that the most effective means should be adopted for preserving for the common use any scrap of information on these matters which may at any time transpire, and that workers in these subjects should constantly compare notes of their experience from an unimpassioned and disinterested point of view. The second requisite that of a special education-is demanded by the necessity of placing oneself on a level with the intelligence of the unlearned questioner-a most difficult task. The third is absolutely necessary as a guarantee for impartiality and the avoidance of unconscious misrepresentation. It is obvious that the profession as a body does not possess these qualifications for the peculiar duties of scientific instructors of the state. To credit the average general practitioner, pure surgeon, or pure physician, with such qualifications, would be transparent flattery, for neither the special literature which we possess, nor the requirements of our educating and examining bodies, nor the relations in which the majority of practitioners are placed towards society, afford any means for their attainment. To take one instance out of many: How frequently does the state require information in questions of lunacy-a subject on which there exists hardly the commencement of a literature, which is taught in almost none of our schools, and examined on by almost none of our licensing bodies, and which more than any other involves questions in which the private interests and feelings of the practitionerare frequently engaged. That mistakes are sometimes committed is not at all wonderful under the circumstances; the only wonder is that they are not constantly occurring. The medical profession may certainly be proud of the general behaviour of its members under the stress of most difficult duties suddenly thrown upon them. But a few years since the diseases of the mind were scarcely recognised by the public as belonging specially to the care of doctors: lunacy was a condition the management of which was for the most part relegated to the charge of ignorant amateurs. Reform in these ideas has been brought about by the efforts of a few eminent physicians, and now the public not only encourages doctors to assume the treatment of mental affections, but thrusts upon them the most onerous and responsible labours in connexion with this department of pathology, and is inclined to treat with great severity any lapses in the fulfilment of these new functions. The demeanour of the public, and especially of the lawyers, towards doctors in respect of questions of lunacy reminds one of the "venerable rustic, strongheaded but incurably obstinate in his prejudices," of whom De Quincey relates that he treated the whole medical profession as ignorant pretenders, knowing absolutely nothing of the system. which they professed to superintend, and yet every third day was exacting from his own medical attendants some exquisite tour de force, as that they should know or should do something which, if they had known or done, all men would have suspected them reasonably of magic. In short, the whole position of affairs is characteristic of a transition period, which cannot last. Either the medical profession must be entirely relieved of all judicial duties with regard to insane persons, or the state must assist it to perform these duties efficiently, since the community at large is partly respon-sible for the difficulties in which medical men are placed with regard to these matters. If to the enormously difficult subject of lunacy we add the questions of sanitary police and of special evidence on criminal trials, we shall find that here is a branch of science which might well occupy the whole attention of the ablest medical man, and which it is idle to suppose can be mastered by men immersed in the details of ordinary practice. And, accordingly, in that confused and unscientific manner which belongs to the motions of society in countries where the principle of "private enterprise" is allowed its fullest sway, we have commenced attempts to remedy the existing evils. A class of experts, more or less distinctly separated from the common sphere of medical work, and devoted to the instruction of the state on scientific questions, has actually arisen. Of these specialists it may with confidence be said that the most efficient are those who have most completely devoted themselves to their specialty; and this is a very important fact for us. For the question begins to force itself upon the attention of some thinkers-whether it were not best to organize a department of state medicine, the officers of which should have given evidence of a sound general knowledge of medicine, and also of a special acquaintance with the peculiar duties which have been mentioned, to which duties their attention should be thenceforth confined? To this question I do not pretend to give a final answer. Believing, however, that the evils for which it suggests a remedy must needs go on increasing unless something is done in the way of organized reform, I wish to help this proposal to gain further publicity, in order that it may be studied as fully as possible, and that the pros and cons may be duly weighed. A proposal to invite government interference with scientific men is so serious a matter that its promoters are bound to show a strong prima facie case, in the nature of a grave scandal existing. Nothing short of this would induce Englishmen, who have witnessed the magnificent development of science under the system of self-government which this country cherishes, to legislate in the proposed direction. I shall therefore proceed to show, I. That such a scandal does exist; and II. That, while it is unreasonable to expect the profession to provide an efficient remedy for it, there is ground for thinking that the state might do so. I. The present administration of state medicine is discreditable. It is possible to prove this with regard to the working of nearly every department in which the state requires scientific opinion rather than practical scientific action from medical men. 1. With regard to the action of "health officers," like those appointed in the various districts of the metropolis, none can pretend that adequate results are produced by the machinery employed. As the practical management of sanitary reforms is after all left in the hands of the vestrymen, who elect their own medical officer, many abuses will creep in. In the first place it is obvious that a vestry may, and probably sometimes will, select an officer not merely inferior to some others proposed, but absolutely devoid of any qualifications whatever for the office; and secondly, although in most cases our metropolitan health officers are able and in some cases very eminent men, yet the fact that they are controlled in their action by a body of men whose material interests in many cases are likely to be opposed to the carrying out of sanitary reforms, however urgently needed, is a strong reason why their action must be comparatively inefficient. No one who knows the practical working of the system can doubt that this is really the case; much good work has been done, but the sanitary evils of the metropolis are only scratched on the surface. Even in comparatively respectable neighbourhoods, there are whole streets whose inhabitants huddle together like rats, liable to be decimated by any contagious epidemic that may come their way, and scarce vitalised enough to offer common resistance to the simplest attack of acute disease. What does the reader think of such a case as this: a long row of houses built with their backs against a wall, and thus without any thorough ventilation whatever, the back rooms on each floor being mere cupboards without light or air; the other sanitary arrangements in perfect harmony with such a state of things, and the whole place, from garret to cellar, crowded with families of lodgers? I could tell him of such cases, where the medical officer would be powerless to induce any efficient action on the part of the vestry, at least without embroiling himself to an unpleasant and dangerous extent with that august body. And, if London is but moderately supplied with the means of scientifically reforming its sanitary faults, what shall we say of the rural villages, from which there has lately gone forth an odour of physical and moral foulness that has startled even the most apathetic of us? Why, simply that (as a rule) they are not supplied at all, at least with any provision that deserves the name. What local officer of health, parish doctor, or any such functionary, under existing circumstances, could venture to state, with the necessary official cold-bloodedness, the naked truth about the condition of labourers' dwellings (not in general but) on a particular estate? The idea is obviously impracticable. The case of food-adulterations is another instance of the inefficiency of the aid at present rendered by science to the state. Every one, since the revelations of the Lancet Sanitary Commission, is aware how extensive, and in many cases injurious, these adulterations are; but to hope for efficient reform by the help of any machinery at present existing would be visionary. How could an officer of health report on the sand in the sugar or currants sold by an important vestryman or guardian, supposing him to be dependent on that individual and his friends for continuance in his public office, and also for employment in his private capacity? The very reason why one department of food-inspection that of meat, fish, poultry, &c.-really is worked with some efficiency exactly illustrates the unfitness of any medical man engaged in ordinary practice to exercise censorial duties over the provision shops generally. This inquisition is effective because the weight and burden can be assumed by a lay inspector, who is in a comparatively independent position, not having to make his livelihood out of the favour of the general public; while the medical officer is only consulted as a referee, the strictly scientific questions being few and generally simple. But for an effective inspection of provisions generally scientific knowledge would be constantly required, and the burden of the work must fall upon the medical officer; yet how could he report with conscientious - candour on the shortcomings of his vestrymen and his patients? 2. The next class of duties which medical men are supposed to render to the state, but which are inefficiently performed, is the furnishing of information as to the causes of deaths occurring in their districts. It is now well known by all statisticians who have considered the subject that our national system of death-registration (considered as a complete record) is a mockery and delusion. This is not so much from carelessness on the part of doctors as from the fact that in an immense number of instances they are never appealed to at all, but the ignorant lay-registrar, wishing to gain a character for zeal, evolves the cause of death which he assigns in the certificate out of his own moral consciousness. Closely connected with this subject is that of the non-registration of still births ; a practice which the law allows to go on, although it has been repeatedly denounced as a fertile source of infanticide. It is obvious that, if the medical profession is ever to give really reliable information to the state on this matter of the cause of deaths, it can only be done by the whole business of deathregistration offices being placed in the hands of medical men ; but, if this were once arranged, we might hope not merely for greatly increased accuracy of information on such questions as we already require to be answered, but most valuable suggestions for improvements of the laws which bear on the personal comfort, health, and safety of our citizens. 3. With regard to the manner in which medical evidence is taken on coroners' inquests, it is almost impossible to overstate the evils of the present system. Our best example, perhaps, will be one which is of very frequent occurrence, namely, the investigation of a case where there is room for suspicion of infanticide, the proof turning mainly on the question whether the child was live-born? The majority of such cases present physiological problems of the deepest kind, such as would require an expert of the highest knowledge and skill to investigate them successfully, and a rather unusual power of interpretation to convey to laymen a just idea of the points of certainty and of uncertainty involved. The long and peculiar study of this subject from two quite distinct points of view-the medical and legal-which would be necessary in order to achieve this kind of success, makes it quite impossible that a busy practitioner, fully engaged with ordinary duties, can acquire it. It needs but a slight cross-examination from an incredulous coroner to break down the credit of such a witness, for in nine cases out of ten his opinion (whether right or wrong) will be found. to have been based, not on a comprehensive survey and accurate analysis of all the scientific indications, but on the result of some specific test which he believes to be crucial, when it may be merely an exploded fallacy. This is an especial danger of medico-legal inquiry in cases of infanticide. The consequences are most disastrous to the cause of justice, and highly conducive to the spread of crime. Juries are now for the most part very distrustful of such evidence, and, where it bears against an actual prisoner, will eagerly seek any loophole to escape from the fatal inference which it suggests a proceeding all the more easy as, in the present state of the law as to child-murder, the public sympathy is nearly always on the side of the accused. It is impossible to doubt that this laxity of repression has much to do with the enormous prevalence of infanticide, which is an undoubted and most dreadful facta stain on our civilization, which has been repeatedly though vainly denounced. 4. In criminal trials a variety of questions arise in which medical evidence forms the turning-point, of which perhaps the most frequently occurring and most important are inquiries into the relation of particular symptoms to the effects of poison. The condition of an ordinary practitioner, unskilled in this kind of investigation, when placed in circumstances where he must give a decided opinion on such a question, is most pitiable. He may have gained a correct enough idea of the case by mental operations, which are, so to speak, irregular-that is to say, they do not admit of being analysed and laid bare to a smart, confident, and hostile barrister, and a jury entirely unfamiliar with medical subjects. His explanation of the manner in which he arrived at his opinion on the case may with ease be made to appear ridiculous and inconsistent, whereas his deficiency was not in sound knowledge and judg ment, but in the power to translate his thoughts into those of unlearned men. Too often, however, it must be allowed that the average practitioner is not possessed of the special knowledge which alone could confer the right to pronounce a decided opinion on such cases. But it is strange to see how nearly universal is the habit of assuming that, provided an expert has the requisite knowledge of special facts, his giving evidence involves no more difficulty than every common witness experiences, when, in fact, there is a difference between the two cases almost as great as between light and darkness. Let any one study with care some text-book of the laws of evidence (such, for instance, as the chapters on evidence in Mr. Fitzjames Stephen's admirable work on the "Criminal Law of England"), and he will perceive that the examination of testimony in courts of law is necessarily guided by an elaborate theory and by special rules of practice, which it requires the skill and knowledge that a special study alone can confer to employ with effect in eliciting the true value of the statements of a witness. For dealing with common facts the kind of knowledge and skill possessed by an acute counsel is doubtless the best preparation. But it is quite impossible for counsel to have any idea how to assist or to compel a scientific witness to that castigatio trutine which should make the naked truth (so far as known to science) appear, stripped of the vestments of private theory and speculative crotchet. I am compelled to demur to the very high estimate which Mr. Stephen has placed on the value of cross-examination in this respect; and, lest I should seem to speak rashly, I will give a specific and forcible instance of the correctness of my view. On the trial of Smethurst one of the most important questions was as to the possibility or otherwise of Miss Bankes's symptoms having been caused by dysentery. Looking back on the hubbub of contradictions which arose on this point, it is difficult to realize the fact-which, nevertheless, assuredly is a fact that the whole matter really lay in a nutshell. The question on this point was, Does English dysentery ever cause a totality of symptoms such as Miss Bankes suffered from. One witness declared that he had seen many cases of dysentery in this country presenting severe symptoms and ending fatally. The circumstance which I desire to point out is this-that it never occurred to counsel to inquire, in crossexamination of this witness, (a) whether his fatal cases had not uniformly occurred in persons who had previously visited a tropical country and suffered from dysentery there; and (b) whether there was reason to believe that Miss Bankes had ever resided within the tropics, or contracted tropical disease? The least learned person can see that that was a great blunder; yet it was precisely what might be expected from a layman dealing with the intricacies of science. But the crowning offence against justice and common sense, in the reception of medical testimony on trials, consists in allowing and indeed requiring it to be given ex parte, the universal practice in this country. Experience has abundantly proved that by such a method of taking skilled evidence (whether medical, or engineering, or of any other kind) nothing but a mass of contradiction will be obtained; but the worth of medical testimony is especially damaged by it, because medical problems are considerably farther removed than others from the scope of ordinary education, and their interpretation is proportionably more difficult. The most absoluté impartiality would be required to enable a witness to execute with complete success the task of opening the eyes of laymen to the exact position of scientific inquiry on many points of toxicology: but the present system excludes the possibility of even a tolerable approach to fairness in any case which is of sufficient interest to provoke a contest. The laws of human nature inexorably forbid us to hope that, with such numerous excuses for forming opinions in a crotchety or theoretical manner as are furnished by medico-legal questions, the average medical witness will ever hold the balance true against the pressure of material interest and the temptation of professional rivalry. There is a cynical insincerity in pretending to expect any such result, which deserves grave reprobation. It is certain that, until means shall be provided for obtaining scientific evidence which has been formed apart from the injurious pressure of interested considerations, we are only making believe to elicit the truth sc far as it can be decided on scientific grounds. 5. Passing by some minor functions which medicine might perform for the state, we come now to the most important and the most miserably neglected of all-the assistance which medical advice should give to the state authorities in questions as to mental unsoundness. The present condition of things in this country, with regard to the forensic aspect of lunacy, is one which our posterity will look back upon with incredulous wonder and disgust. It is confessed by every psychologist who is worth his salt that our knowledge of mental pathology is still in its infancy: at the same time it is known to every observer of the progress of medical science that we have now entered upon a path which must lead to great and valuable discoveries in the future, and has already led to some which are very important. In short, our mental science is in a peculiarly developmental state; that is, in a state which of all others renders it difficult for a layman to discriminate between that which is solid |