THE BRI18H MEDICAL JO 361 The first two of these propositions may well be discussed together, as the second is only a corollary of the flrst. It is true of laryngology as of so many other things, that its greatest adversaries are those who know least of it. Our first .aim, therefore, ought to be that every qualifled practitioner ought to be acquainted with it. Now it is perfectly true that in this country, as well as elsewhere, there are a good many students who alread during their hospital

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... er understand that they do not learn for examninations, but for life, and who eagerly seize upon every opportunity of becoming thoroughly acquainted with every progress of modern medicine. For such men no compulsion is ziecessary. Unfortunately, however, men of this stamp are, and are likely to remain, in a minority; and to the great mass of students those subjects only appear important which are prescribed by the official curriculum, and form part of the examinations. Considering the frequency and importance of throat and nose affections, and the light thrown by the laryngoscope upon severe diseases of distant parts, it appears urgently desirable, first, that attendance on a practical course of laryngology and rhinology should be made compulsory; secondly, that proficiency in these two subjects should be tested in the finlal examination. To avoid all misunderstandings, however, I beg to say distinctly that I do not propose to harass the already overburdened student with a separate laryngological examination, conducted by a specialist, ,but merely that the extent of his acquaintance with the use of the larngoscope and rhinoscope should be ascertained in the course of his clinical examination, and that ignorance in these respects should be noted against him, in the same way as deficiency in any of the other recognised methods of physical examination. Concerning the organisation of the throat departments of the teaching hospitals, the wish may fairly be expressed, that they should be all placed in the charge of gentlemen taking more -than transitory interest in the subjects they are called upon to teach, and further, that the principle of rapid rotation of clinical assistants, wlich may answer well enough in the general departments, should not be extended to special branchee, demanding a technique which necessarily can only be acquired in the course of time. So long as the present principle of a three-, or at the best, six-montlhly change of the clinical assistants is conltiiued, the work (f the head of the department is a real Sisyphus-task. He loses his helpers just at the moment when they becomne really useful to the department; lie has personally to do mnuch work, which ouight to be, and is elsewhere, left to the aseistants; he -cannot devote sufficient time to the really important cases, and above all, he is prevented from fulfilling to its full extenlt what I consider his most important duty, namely, to instruct the stu--dents. This is a question of the highest importance, aiid I hope that the authorities will soon admit that the preseint system J)enefits a few students at the expense of the many, and in a larger sense, of the lpublic in general. in the present circumstances we sball never be able to compete witlh the tliroat .cliniques abroad, to which so many English and American BtUdents flock, not because they beat us with regard to material, or to experience, but merely on account of their superior practical -arrangements. Perhaps it may some day be possible to organise .in that great clinical centre, London, an association of teachers, -similar to those formed in so many Continental universities, whereby the opportunity may be given to students and practi-,tioners to utilise, better than is possible at present, the time they wish to devote to the study of throat and nose diseases. Whilst, for instance, at Vieinna tlle budding laryngologist has the oppor-.tunity of devoting himself from 8 A.m. to 1 P.M., without interruption, to the study of Ills favourite subject, uinder the guidance of four different able and experienced teachers, at London, with its infinitely larger material, with but few exceptions, the hours .of attendance at tlle throat departments of the teaching hospitals, as well as at the special hospitals, are from 2 to 4 P.mr., and the -student has hardly an opportunity of visiting more than one -throat clinique in the course of the day. This fact forms a standing complaint of foreign v-isitors, who wish to make the most of -their limited time. It will probably be difficult to make satisfactory arrangements with regard to all these points, upon which I could but hurriedly touch to-day, but the tquestions ought to be .submitted to consideration, in order to be satisfactorily solved in .the future. I now come to the last part of my task, the advocacy of greater .dissemination of laryngological knowledge by papers brought forward in general medical societies. I trust that the whole gist of tthis address has not left it doubtful to the minds of my hearers in what direction, according to my opinion, the true progress of laryngology must be sought for. I say it is in remaining intimately connected with our mother science, with medicine and surgery in general. We may and must try to obtain so much independence as is absolutely required for the sound development of our branch, but we ouglht not, I think, to be led astray by a false ambition for independence at any price, and we ought to avoid the fatal mistake of becoming isolated. From this point of view I recommetid as the best bond of union between general medicine and laryngology and rhinology the frequent reading of papers of common interest in general medical societies, to be discussed by specialists, physicians, surgeons, and general practitioners in union, and to be published in general medical journals. From the same point of view I cannot but express my regret at the formation of a special Laryngological and Rliinological Society. Two years ago I fully stated my reasons for opposing such special societies when the same plan wtis brought forward in Germany, an(l all the objections I then raised and victoriously maintained apply, I think, with still greater force to this country. I do not doubt for a moment that wlen my friend Dr. Whistler last year brouglt forward his suggestion, whlicl since has taken practical shape, he was actuated by the most ideal motives, but in this as in so many other questions theory and practice unfortunately differ. Had this Association obstinately refused to grant a position to laryngology, the formation of a special Society would 1liave been intelligible enouigh. As matters, however, actually stand there is, plainly speaking, but too much reason to fear that there wilfbe always a latent rivalry between the new Society and the Laryngological Svetions of this Association, splitting up the few British laryngologists into two camps, and leading to insufficient attendance at the meetings of either. Mloreover, although there are undoubtedly some questions continuously arising, such as we shall have presently before us, which can be better discussed in a smaller circle of experts than in a large general Society, the number of these questions is very small, an(d they can be quite sufflciently discussed at the annual meetings of this Association. Again, it is almost certain that, in order to fill up the programme of the meeting of the new Society, a number of papers will be read on these occasions which miglht have been brought forward with much greater advantage before general medical societies. Several other reasons strongly speaking against a separation from the general body could be adduced, but what I have said will I tlhink justify my fears that, far from benefiting larngology, this departure will only lead to its isolation. I wish I may te mistaken, but I do not believe it. My own conviction is that no specialty can lastingly flourislh which aims at independence at the expense of too complete a separation from the general body; and a specialty like ours, wlich possesses so many points of common interest with medicine and surgery in general, with neurology. with otology, witli children's diseases, with public medicine, and with numerous other branches, ought, I strongly feel, ratlher to work in connection with them, and to impart ideas to and receive ideas from territories apparently rather distant from our own, than to retire into its own little snail-shell, and, there to lead a self-satisfied existence. Cultivation of intimate relations with our great mother science, in hoc signo Vincemus, and under this motto we will now begin our common work.